Provider Demographics
NPI:1982384483
Name:RAPID CITY ORAL SURGERY PROF LLC
Entity Type:Organization
Organization Name:RAPID CITY ORAL SURGERY PROF LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER/TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:ISAAC
Authorized Official - Middle Name:
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:605-430-5625
Mailing Address - Street 1:330 E STUMER RD
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-6406
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:330 E STUMER RD
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-6406
Practice Address - Country:US
Practice Address - Phone:605-348-3400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BLACK HILLS ORAL AND MAXILLOFACIAL SURGERY, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-07-19
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Single Specialty