Provider Demographics
NPI:1790882306
Name:HOUK, MICHAEL BRUCE (DDS)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:BRUCE
Last Name:HOUK
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 1:1704 S CLEVELAND AVE
Mailing Address - Street 2:STE 4
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57103
Mailing Address - Country:US
Mailing Address - Phone:605-331-5656
Mailing Address - Fax:605-367-1115
Practice Address - Street 1:1704 S CLEVELAND AVE
Practice Address - Street 2:STE 4
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57103
Practice Address - Country:US
Practice Address - Phone:605-331-5656
Practice Address - Fax:605-367-1115
Is Sole Proprietor?:No
Enumeration Date:2006-09-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDM-4541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD7802570Medicaid