Provider Demographics
NPI:1134238058
Name:STEVEN NORBERG,D.D.S., P.C.
Entity type:Organization
Organization Name:STEVEN NORBERG,D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:NORBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:605-335-3175
Mailing Address - Street 1:5009 W 12TH ST STE 3
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57106-3908
Mailing Address - Country:US
Mailing Address - Phone:605-335-3175
Mailing Address - Fax:605-335-3176
Practice Address - Street 1:5009 W 12TH ST STE 3
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57106-3908
Practice Address - Country:US
Practice Address - Phone:605-335-3175
Practice Address - Fax:605-335-3176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDM5091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0936104Medicaid
SD=========Medicaid