Provider Demographics
NPI:1861549883
Name:DAKOTA DENTAL CLAY YEOMAN DDS PROF. LLC
Entity type:Organization
Organization Name:DAKOTA DENTAL CLAY YEOMAN DDS PROF. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CLAY
Authorized Official - Middle Name:LEWIS
Authorized Official - Last Name:YEOMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:605-472-3700
Mailing Address - Street 1:517 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:REDFIELD
Mailing Address - State:SD
Mailing Address - Zip Code:57469-1208
Mailing Address - Country:US
Mailing Address - Phone:605-472-3700
Mailing Address - Fax:
Practice Address - Street 1:517 N MAIN ST
Practice Address - Street 2:
Practice Address - City:REDFIELD
Practice Address - State:SD
Practice Address - Zip Code:57469-1208
Practice Address - Country:US
Practice Address - Phone:605-472-3700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDM9851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty