Provider Demographics
NPI:1497476097
Name:BROOKINGS EMBRACE DENTAL CLINIC LLC
Entity Type:Organization
Organization Name:BROOKINGS EMBRACE DENTAL CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:JEANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-884-9341
Mailing Address - Street 1:2220 YORKSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:BROOKINGS
Mailing Address - State:SD
Mailing Address - Zip Code:57006-2442
Mailing Address - Country:US
Mailing Address - Phone:605-697-6262
Mailing Address - Fax:605-307-1550
Practice Address - Street 1:2220 YORKSHIRE DR
Practice Address - Street 2:
Practice Address - City:BROOKINGS
Practice Address - State:SD
Practice Address - Zip Code:57006-2442
Practice Address - Country:US
Practice Address - Phone:605-697-6262
Practice Address - Fax:605-307-1550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-12
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty