Provider Demographics
NPI:1649471962
Name:HRUBY DENTAL PC
Entity type:Organization
Organization Name:HRUBY DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:HRUBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-345-3000
Mailing Address - Street 1:101 PEABODY DR
Mailing Address - Street 2:SUITE #3
Mailing Address - City:WEBSTER
Mailing Address - State:SD
Mailing Address - Zip Code:57274-1061
Mailing Address - Country:US
Mailing Address - Phone:605-345-3000
Mailing Address - Fax:605-345-3001
Practice Address - Street 1:101 PEABODY DR
Practice Address - Street 2:SUITE #3
Practice Address - City:WEBSTER
Practice Address - State:SD
Practice Address - Zip Code:57274-1061
Practice Address - Country:US
Practice Address - Phone:605-345-3000
Practice Address - Fax:605-345-3001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2012-11-07
Deactivation Date:2012-05-09
Deactivation Code:
Reactivation Date:2012-11-07
Provider Licenses
StateLicense IDTaxonomies
SDM9161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty