Provider Demographics
NPI:1700259496
Name:CHRIS DICKES FAMILY DENTISTRY, PROF. LLC
Entity Type:Organization
Organization Name:CHRIS DICKES FAMILY DENTISTRY, PROF. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:D
Authorized Official - Last Name:DICKES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:605-376-7256
Mailing Address - Street 1:1000 W 4TH ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:YANKTON
Mailing Address - State:SD
Mailing Address - Zip Code:57078-3700
Mailing Address - Country:US
Mailing Address - Phone:605-660-8409
Mailing Address - Fax:605-665-4584
Practice Address - Street 1:1704 S CLEVELAND AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57103-3903
Practice Address - Country:US
Practice Address - Phone:605-660-8409
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHRIS DICKES FAMILY DENTISTRY, PROF. LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-11-04
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDD05191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty