Provider Demographics
NPI:1417180969
Name:DENTISTRY AT THE ST. CHARLES LLC
Entity Type:Organization
Organization Name:DENTISTRY AT THE ST. CHARLES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT DENTISTRY AT THE ST CHARL
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:C
Authorized Official - Last Name:SZANA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:605-224-2161
Mailing Address - Street 1:207 E. CAPITOL AVE. STE 201
Mailing Address - Street 2:
Mailing Address - City:PIERRE
Mailing Address - State:SD
Mailing Address - Zip Code:57501
Mailing Address - Country:US
Mailing Address - Phone:605-224-2161
Mailing Address - Fax:605-224-1202
Practice Address - Street 1:207 E. CAPITOL AVE. STE 201
Practice Address - Street 2:
Practice Address - City:PIERRE
Practice Address - State:SD
Practice Address - Zip Code:57501
Practice Address - Country:US
Practice Address - Phone:605-224-2161
Practice Address - Fax:605-224-1202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-01
Last Update Date:2009-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty