| Cheyenne River Dental Clinic | |
|
24276 166th St Eagle Butte SD 57625-8141 | |
| (605) 964-0736 | |
| (605) 964-7800 |
| Full Name | Cheyenne River Dental Clinic |
|---|---|
| Speciality | Dentist - Dental Public Health |
| Location | 24276 166th St, Eagle Butte, South Dakota |
| Authorized Official Name and Position | Tiffany L Larson (CRST DENTAL ADMINISTRATIVE MANAGER) |
| Authorized Official Contact | 6059640736 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Cheyenne River Dental Clinic Po Box 590 Eagle Butte SD 57625-0590 Ph: (605) 964-0736 | Cheyenne River Dental Clinic 24276 166th St Eagle Butte SD 57625-8141 Ph: (605) 964-0736 |
| NPI Number | 1851422596 |
|---|---|
| Provider Enumeration Date | 03/07/2007 |
| Last Update Date | 08/05/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851422596 | NPI | - | NPPES |
| 5540240 | Medicaid | SD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223D0001X | Dentist - Dental Public Health | (* (Not Available)) | Primary |