1063593275 NPI number — MARK A BIERSCHBACH D.D.S., P.C.

Table of content: (NPI 1063593275)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063593275 NPI number — MARK A BIERSCHBACH D.D.S., P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARK A BIERSCHBACH D.D.S., P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063593275
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 592
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MILBANK
Provider Business Mailing Address State Name:
SD
Provider Business Mailing Address Postal Code:
57252-0592
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
605-432-5032
Provider Business Mailing Address Fax Number:
605-432-4844

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1203 EAST 4TH AVE.
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
MILBANK
Provider Business Practice Location Address State Name:
SD
Provider Business Practice Location Address Postal Code:
57252
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-432-5032
Provider Business Practice Location Address Fax Number:
605-432-4844
Provider Enumeration Date:
10/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BIERSCHBACH
Authorized Official First Name:
MARK
Authorized Official Middle Name:
ALAN
Authorized Official Title or Position:
DENTIST
Authorized Official Telephone Number:
605-432-5032

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  M482 , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 837660 . This is a "UNITED CONCORDIA/TRICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7801810 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 989074 . This is a "BLUECROSS BLUESHIED OF ND" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".




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