Provider Demographics
NPI:1952149395
Name:UNKENHOLZ FAMILY DENTAL, PROF LLC
Entity type:Organization
Organization Name:UNKENHOLZ FAMILY DENTAL, PROF LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:G
Authorized Official - Last Name:UNKENHOLZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:605-431-5774
Mailing Address - Street 1:1301 W OMAHA ST STE 228
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-2422
Mailing Address - Country:US
Mailing Address - Phone:605-342-2445
Mailing Address - Fax:
Practice Address - Street 1:1301 W OMAHA ST STE 228
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-2422
Practice Address - Country:US
Practice Address - Phone:605-342-2445
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNKENHOLZ FAMILY DENTAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-07-18
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental