1356819718 NPI number — THE DENTIST AT ELK POINT, PC

Table of content: (NPI 1356819718)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356819718 NPI number — THE DENTIST AT ELK POINT, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE DENTIST AT ELK POINT, PC
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:
ELK POINT DENTAL CARE, CRAIG N, BURHOOP, DDS, PC
Provider Other Organization Name Type Code:
4
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:
1356819718
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/10/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
333 LAKESHORE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH SIOUX
Provider Business Mailing Address State Name:
SD
Provider Business Mailing Address Postal Code:
57049
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
712-259-3299
Provider Business Mailing Address Fax Number:
712-276-8403

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
109 E MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELK POINT
Provider Business Practice Location Address State Name:
SD
Provider Business Practice Location Address Postal Code:
57025
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-356-2271
Provider Business Practice Location Address Fax Number:
605-356-2302
Provider Enumeration Date:
11/05/2018

Additional Information

Authorized Official

Authorized Official Last Name:
BURHOOP
Authorized Official First Name:
CRAIG
Authorized Official Middle Name:
NOEL
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
605-356-2271

Provider Taxonomy Codes

  • Taxonomy code: 261QD0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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