Provider Demographics
NPI:1629057666
Name:DIERKS, DUSTIN L (MD)
Entity Type:Individual
Prefix:DR
First Name:DUSTIN
Middle Name:L
Last Name:DIERKS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:6601 S MINNESOTA AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-2563
Mailing Address - Country:US
Mailing Address - Phone:605-336-6294
Mailing Address - Fax:605-336-0266
Practice Address - Street 1:6601 S MINNESOTA AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108
Practice Address - Country:US
Practice Address - Phone:605-336-6294
Practice Address - Fax:605-336-0266
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2023-01-03
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Provider Licenses
StateLicense IDTaxonomies
MN47406207W00000X
SD7144207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
1629057666OtherMEDICA
SD63015200Medicaid
MN701180600Medicaid
7144OtherDAKOTACARE
NE46031185613Medicaid
HP51305OtherHEALTH PARTNERS
IA1629057666Medicaid
SD4992316OtherBCBC OF SD
MN132768OtherUCARE
MN10B10DIOtherBCBS OF MN
IA1629057666OtherBCBS OF IA
HP51305OtherHEALTH PARTNERS
SD4992316OtherBCBC OF SD