Provider Demographics
NPI:1578986808
Name:UNKENHOLZ FAMILY DENTAL, PROF LLC
Entity Type:Organization
Organization Name:UNKENHOLZ FAMILY DENTAL, PROF LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:GRANT
Authorized Official - Last Name:UNKENHOLZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:605-399-9000
Mailing Address - Street 1:710 MOUNT RUSHMORE RD
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-3609
Mailing Address - Country:US
Mailing Address - Phone:605-399-9000
Mailing Address - Fax:605-399-9008
Practice Address - Street 1:710 MOUNT RUSHMORE RD
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-3609
Practice Address - Country:US
Practice Address - Phone:605-399-9000
Practice Address - Fax:605-399-9008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-22
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty