Provider Demographics
NPI:1528226958
Name:SHAWD NEIGHBORHOOD DENTAL CLINIC P.C.
Entity Type:Organization
Organization Name:SHAWD NEIGHBORHOOD DENTAL CLINIC P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:JON
Authorized Official - Last Name:SHAWD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:605-338-2251
Mailing Address - Street 1:229 W 39TH ST
Mailing Address - Street 2:STE. 100
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-5700
Mailing Address - Country:US
Mailing Address - Phone:605-338-2251
Mailing Address - Fax:605-338-2788
Practice Address - Street 1:229 W 39TH ST
Practice Address - Street 2:STE. 100
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-5700
Practice Address - Country:US
Practice Address - Phone:605-338-2251
Practice Address - Fax:605-338-2788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-02
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDM9931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty