Provider Demographics
NPI:1518542927
Name:KIMBERLY A. TRASK, D.D.S., PROF. L.L.C.
Entity Type:Organization
Organization Name:KIMBERLY A. TRASK, D.D.S., PROF. L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:TRASK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-864-0149
Mailing Address - Street 1:104 PHILIP AVE
Mailing Address - Street 2:
Mailing Address - City:PHILIP
Mailing Address - State:SD
Mailing Address - Zip Code:57567
Mailing Address - Country:US
Mailing Address - Phone:605-864-0149
Mailing Address - Fax:
Practice Address - Street 1:104 PHILIP AVE
Practice Address - Street 2:
Practice Address - City:PHILIP
Practice Address - State:SD
Practice Address - Zip Code:57567
Practice Address - Country:US
Practice Address - Phone:605-859-2491
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-17
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty