Provider Demographics
NPI:1497956304
Name:FAMILY, COSMETIC & IMPLANT DENTISTRY, DRS. BERDAHL & FEIOCK, P.C.
Entity Type:Organization
Organization Name:FAMILY, COSMETIC & IMPLANT DENTISTRY, DRS. BERDAHL & FEIOCK, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:C
Authorized Official - Last Name:BERDAHL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:605-332-4751
Mailing Address - Street 1:6301 S MINNESOTA AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-2528
Mailing Address - Country:US
Mailing Address - Phone:605-332-4751
Mailing Address - Fax:605-332-5113
Practice Address - Street 1:6301 S MINNESOTA AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-2528
Practice Address - Country:US
Practice Address - Phone:605-332-4751
Practice Address - Fax:605-332-5113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDM911122300000X
SDM687122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty