Provider Demographics
NPI:1659409316
Name:CARRELS, JOHN MICHAEL (DDS)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:MICHAEL
Last Name:CARRELS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:SD
Mailing Address - Zip Code:57401
Mailing Address - Country:US
Mailing Address - Phone:605-225-1192
Mailing Address - Fax:605-226-7083
Practice Address - Street 1:805 S STATE ST
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:SD
Practice Address - Zip Code:57401
Practice Address - Country:US
Practice Address - Phone:605-225-1192
Practice Address - Fax:605-226-7083
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDM7271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
995493OtherDSC
SD7809990Medicaid
758677OtherUNITED CONCORDIA