# BLACK HILLS PEDIATRIC DENTISTRY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1194867499
- **Authorized official:** MRS. PAMM TOROK-HOBEN (CEO)
- **Authorized official phone:** (605) 341-3068

## Contact information

- **Practice address:** 700 SHERIDAN LAKE RD, RAPID CITY, SD 57702-2407
- **Practice address phone:** (605) 341-3068
- **Practice address fax:** (605) 341-5757
- **Mailing address:** 700 SHERIDAN LAKE RD, RAPID CITY, SD 57702-2407
- **Mailing address phone:** (605) 341-3068
- **Mailing address fax:** (605) 341-5757

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223P0221X | Pediatric Dentistry | — | NULL | Yes |
| 1223P0221X | Pediatric Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 02/13/2007
- **Last updated:** 08/17/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 100249748-00 | — | NE |
| 05 | — | 118314100 | — | WY |
| 05 | — | 7805000 | — | SD |