Provider Demographics
NPI:1750911566
Name:INFINITY IMPLANT AND SEDATION LLC
Entity type:Organization
Organization Name:INFINITY IMPLANT AND SEDATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:JEANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-878-0456
Mailing Address - Street 1:2310 9TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:SD
Mailing Address - Zip Code:57201-7112
Mailing Address - Country:US
Mailing Address - Phone:605-878-0456
Mailing Address - Fax:605-886-5209
Practice Address - Street 1:2310 9TH AVE SE
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:SD
Practice Address - Zip Code:57201-7112
Practice Address - Country:US
Practice Address - Phone:605-878-0456
Practice Address - Fax:605-886-5209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-21
Last Update Date:2020-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental