| Dba/ Destination Dentistry | |
|
141 N 5th St Custer SD 57730-1528 | |
| (605) 673-2011 | |
| Not Available |
| Full Name | Dba/ Destination Dentistry |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 141 N 5th St, Custer, South Dakota |
| Authorized Official Name and Position | Diana Latinow (DENTIST / OWNER) |
| Authorized Official Contact | 6056732011 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Dba/ Destination Dentistry 141 N 5th St Custer SD 57730-1528 Ph: (605) 673-2011 | Dba/ Destination Dentistry 141 N 5th St Custer SD 57730-1528 Ph: (605) 673-2011 |
| NPI Number | 1043351018 |
|---|---|
| Provider Enumeration Date | 02/10/2007 |
| Last Update Date | 08/02/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043351018 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | M-490 (South Dakota) | Primary |
Custer Dental Studio Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 141 N 5th St, Custer, SD 57730 Phone: 605-321-2086 |