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Contact Information

CHEYENNE RIVER DENTAL CLINIC
24276 166TH ST
EAGLE BUTTE, SD57625-8141
 Phone: 605-964-0736
 Fax: 605-964-7800
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Dental Public Health

1223D0001X
Indicates primary specialty

NPI Profile & details for CHEYENNE RIVER DENTAL CLINIC

NPI # 1851422596
LBN Legal business name CHEYENNE RIVER DENTAL CLINIC
Authorized official TIFFANY LARSON - (CRST DENTAL ADMINISTRATIVE MANAGER)
Entity Organization
Organization subpart 1 No
Enumeration date 03/07/2007
Last updated 08/05/2022 - About 4 years ago
Identifiers
SD Medicaid 5540240
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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