| NPI | 1790757011 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PEGGY KRISTIN ROTH Insurance Administrator 605-335-1080 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Enumeration Date | 2006-02-02 |
| Last Update Date | 2015-04-14 |