Provider Demographics
NPI:1770895765
Name:JOHN M. CARRELS
Entity type:Organization
Organization Name:JOHN M. CARRELS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:M
Authorized Official - Last Name:CARRELS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:605-225-1192
Mailing Address - Street 1:PO BOX 667
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:SD
Mailing Address - Zip Code:57437-0667
Mailing Address - Country:US
Mailing Address - Phone:605-284-2461
Mailing Address - Fax:
Practice Address - Street 1:708 G AVE
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:SD
Practice Address - Zip Code:57437
Practice Address - Country:US
Practice Address - Phone:605-284-2461
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JOHN M. CARRELS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-07-08
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty