Provider Demographics
NPI:1508114695
Name:UNIVERSITY OF SOUTH DAKOTA DENTAL HYGIENE
Entity Type:Organization
Organization Name:UNIVERSITY OF SOUTH DAKOTA DENTAL HYGIENE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRPERSON
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUNICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-677-5379
Mailing Address - Street 1:414 E CLARK ST
Mailing Address - Street 2:120 EAST HALL
Mailing Address - City:VERMILLION
Mailing Address - State:SD
Mailing Address - Zip Code:57069-2307
Mailing Address - Country:US
Mailing Address - Phone:605-677-5379
Mailing Address - Fax:605-677-5638
Practice Address - Street 1:414 E CLARK ST
Practice Address - Street 2:120 EAST HALL
Practice Address - City:VERMILLION
Practice Address - State:SD
Practice Address - Zip Code:57069-2307
Practice Address - Country:US
Practice Address - Phone:605-677-5582
Practice Address - Fax:605-677-5638
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNIVERSITY OF SOUTH DAKOTA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-08-21
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDD0802261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental