Provider Demographics
NPI:1538931175
Name:ST.FRANCIS MISSION DENTAL CLINIC
Entity type:Organization
Organization Name:ST.FRANCIS MISSION DENTAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARTY
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:RDH
Authorized Official - Phone:605-747-2142
Mailing Address - Street 1:PO BOX 499
Mailing Address - Street 2:
Mailing Address - City:SAINT FRANCIS
Mailing Address - State:SD
Mailing Address - Zip Code:57572-0499
Mailing Address - Country:US
Mailing Address - Phone:605-747-2142
Mailing Address - Fax:605-747-2455
Practice Address - Street 1:350 S OAK ST
Practice Address - Street 2:
Practice Address - City:ST FRANCIS
Practice Address - State:SD
Practice Address - Zip Code:57572
Practice Address - Country:US
Practice Address - Phone:605-747-2142
Practice Address - Fax:605-747-2455
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST FRANCIS MISSION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-10-26
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty