Provider Demographics
NPI:1841027851
Name:NBA, PLLC
Entity type:Organization
Organization Name:NBA, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:KATE
Authorized Official - Middle Name:
Authorized Official - Last Name:HAAVE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:605-430-9913
Mailing Address - Street 1:2006 MOUNT RUSHMORE RD STE 1
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-4726
Mailing Address - Country:US
Mailing Address - Phone:605-343-9352
Mailing Address - Fax:605-343-3115
Practice Address - Street 1:2006 MOUNT RUSHMORE RD STE 1
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-4726
Practice Address - Country:US
Practice Address - Phone:605-343-9352
Practice Address - Fax:605-343-3115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-16
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD1871830851Medicaid