Provider Demographics
NPI:1477748275
Name:GREAT PLAINS DENTAL
Entity Type:Organization
Organization Name:GREAT PLAINS DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KRIS
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:MCKINNEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:605-339-2955
Mailing Address - Street 1:5121 S SOLBERG AVE
Mailing Address - Street 2:STE. 120
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-2245
Mailing Address - Country:US
Mailing Address - Phone:605-339-2955
Mailing Address - Fax:605-373-0235
Practice Address - Street 1:5121 S SOLBERG AVE
Practice Address - Street 2:STE. 120
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-2245
Practice Address - Country:US
Practice Address - Phone:605-339-2955
Practice Address - Fax:605-373-0235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-14
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDM8411223G0001X
SDM8671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty