Provider Demographics
NPI:1174153985
Name:EMBRACE DENTISTRY DAKOTA DUNES LLC
Entity type:Organization
Organization Name:EMBRACE DENTISTRY DAKOTA DUNES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:JEANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-884-9341
Mailing Address - Street 1:383 W STEAMBOAT DR STE 101
Mailing Address - Street 2:
Mailing Address - City:NORTH SIOUX CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57049-5390
Mailing Address - Country:US
Mailing Address - Phone:605-232-5898
Mailing Address - Fax:605-232-6844
Practice Address - Street 1:383 W STEAMBOAT DR STE 101
Practice Address - Street 2:
Practice Address - City:NORTH SIOUX CITY
Practice Address - State:SD
Practice Address - Zip Code:57049-5390
Practice Address - Country:US
Practice Address - Phone:605-232-5898
Practice Address - Fax:605-232-6844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-21
Last Update Date:2020-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental