Dental Yellow Pages

Dental Yellow Pages

Dentists, Dental Clinics and Practices
Oral Surgery, Dental Specialists

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BLACK HILLS ORAL & MAXILLOFACIAL SURGERY PC

Oral and Maxillofacial Pathology

Rapid City, South Dakota

Provider NPI: 1063486926

Organization Information:
Organization Name:  BLACK HILLS ORAL & MAXILLOFACIAL SURGERY PC
Organization is not Subpart
Authorized Official:  ROGER CAVE WILSON  PRESIDENT  605-3486818

Practice Location:
3415 5TH ST  RAPID CITY, SD 57701 US
Tel: 605-348-6818  Fax: 605-348-4690

Business Mailing Address:
PO BOX 5690  RAPID CITY, SD 57709 US
Tel: 605-348-6818  Fax: 605-348-4690

Entity Type: Organization

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
Y1223P0106XDental Providers
Dentist
Oral and Maxillofacial Pathology
SDM367

Other Provider Identifiers:

IssuerNumberStateType
8000050SD05
8000140SD05
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin



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