| Faith Dental Clinic | |
|
112 N 2nd Ave. W Faith SD 57626-0577 | |
| (605) 967-2644 | |
| (605) 967-2844 |
| Full Name | Faith Dental Clinic |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 112 N 2nd Ave. W, Faith, South Dakota |
| Authorized Official Name and Position | John Mengenhausen (CEO) |
| Authorized Official Contact | 6057724514 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Faith Dental Clinic 112 N 2nd Ave. W Po Box 577 Faith SD 57626-0577 Ph: (605) 967-2644 | Faith Dental Clinic 112 N 2nd Ave. W Faith SD 57626-0577 Ph: (605) 967-2644 |
| NPI Number | 1760933246 |
|---|---|
| Provider Enumeration Date | 10/19/2016 |
| Last Update Date | 10/19/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760933246 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Secondary |
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |