Provider Demographics
NPI:1508164401
Name:BECHTOLD THOMPSON DENTAL CLINIC
Entity Type:Organization
Organization Name:BECHTOLD THOMPSON DENTAL CLINIC
Other - Org Name:PIERRE DENTAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MONTY
Authorized Official - Middle Name:D
Authorized Official - Last Name:BECHTOLD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-224-5355
Mailing Address - Street 1:640 E. SIOUX AVE
Mailing Address - Street 2:
Mailing Address - City:PIERRE
Mailing Address - State:SD
Mailing Address - Zip Code:57501
Mailing Address - Country:US
Mailing Address - Phone:605-224-5355
Mailing Address - Fax:605-224-4846
Practice Address - Street 1:640 E. SIOUX AVE
Practice Address - Street 2:
Practice Address - City:PIERRE
Practice Address - State:SD
Practice Address - Zip Code:57501
Practice Address - Country:US
Practice Address - Phone:605-224-5355
Practice Address - Fax:605-224-4846
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-02
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDM5831223G0001X
SDD05131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty