Provider Demographics
NPI:1962606285
Name:MARK C NIELSEN DDS PC
Entity type:Organization
Organization Name:MARK C NIELSEN DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JANE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:TURNER
Authorized Official - Suffix:
Authorized Official - Credentials:CDA ADA
Authorized Official - Phone:605-224-7774
Mailing Address - Street 1:465 S PIERRE ST
Mailing Address - Street 2:
Mailing Address - City:PIERRE
Mailing Address - State:SD
Mailing Address - Zip Code:57501-4507
Mailing Address - Country:US
Mailing Address - Phone:605-224-7774
Mailing Address - Fax:605-224-9171
Practice Address - Street 1:465 S PIERRE ST
Practice Address - Street 2:
Practice Address - City:PIERRE
Practice Address - State:SD
Practice Address - Zip Code:57501-4507
Practice Address - Country:US
Practice Address - Phone:605-224-7774
Practice Address - Fax:605-224-9171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDM6071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD7804160Medicaid