| Rushmore Dental | |
|
1600 Mountain View Rd Ste 104 Rapid City SD 57702-4354 | |
| (605) 593-0037 | |
| (605) 593-8351 |
| Full Name | Rushmore Dental |
|---|---|
| Speciality | Dentist |
| Location | 1600 Mountain View Rd Ste 104, Rapid City, South Dakota |
| Authorized Official Name and Position | Timothy Lynn Kelly (OWNER) |
| Authorized Official Contact | 6055930037 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Rushmore Dental 1600 Mountain View Rd Ste 104 Rapid City SD 57702-4354 Ph: (605) 593-0037 | Rushmore Dental 1600 Mountain View Rd Ste 104 Rapid City SD 57702-4354 Ph: (605) 593-0037 |
| NPI Number | 1710433123 |
|---|---|
| Provider Enumeration Date | 08/27/2016 |
| Last Update Date | 08/27/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710433123 | NPI | - | NPPES |
| 1588653281 | Medicaid | SD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | D0505 (South Dakota) | Primary |
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