Provider Demographics
NPI:1366721268
Name:CENTER FOR ADVANCED DENTISTRY
Entity type:Organization
Organization Name:CENTER FOR ADVANCED DENTISTRY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAROLD
Authorized Official - Middle Name:D
Authorized Official - Last Name:OPP
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:605-225-2236
Mailing Address - Street 1:1409 6TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:SD
Mailing Address - Zip Code:57401-4950
Mailing Address - Country:US
Mailing Address - Phone:605-225-2236
Mailing Address - Fax:
Practice Address - Street 1:1409 6TH AVE SE
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:SD
Practice Address - Zip Code:57401-4950
Practice Address - Country:US
Practice Address - Phone:605-225-2236
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-09
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDM0651122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty