Provider Demographics
NPI:1508931007
Name:DR NELSON DR SIGATY FAMILY DENISTRY PROF LLC
Entity Type:Organization
Organization Name:DR NELSON DR SIGATY FAMILY DENISTRY PROF LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:SIGATY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-338-1212
Mailing Address - Street 1:1717 S CLEVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57103
Mailing Address - Country:US
Mailing Address - Phone:605-338-1212
Mailing Address - Fax:
Practice Address - Street 1:1717 S CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57103
Practice Address - Country:US
Practice Address - Phone:605-338-1212
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDD05011223G0001X
SDM2651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty