Provider Demographics
NPI:1750633004
Name:DAKOTA ENT AND SINUS CLINIC, P.C.
Entity Type:Organization
Organization Name:DAKOTA ENT AND SINUS CLINIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:GREGORY
Authorized Official - Last Name:DESAUTEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:605-575-1000
Mailing Address - Street 1:6709 S MINNESOTA AVE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-2592
Mailing Address - Country:US
Mailing Address - Phone:605-575-1000
Mailing Address - Fax:605-575-1004
Practice Address - Street 1:6709 S MINNESOTA AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-2592
Practice Address - Country:US
Practice Address - Phone:605-575-1000
Practice Address - Fax:605-575-1004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-11
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
No207YP0228XAllopathic & Osteopathic PhysiciansOtolaryngologyPediatric OtolaryngologyGroup - Multi-Specialty
No207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic SurgeryGroup - Multi-Specialty
No207YX0602XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngic AllergyGroup - Multi-Specialty
No207YX0901XAllopathic & Osteopathic PhysiciansOtolaryngologyOtology & NeurotologyGroup - Multi-Specialty
No207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic SurgeryGroup - Multi-Specialty