# SIOUXLAND DENTAL HEALTH - SOUTH SIOUX, LLC

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

## Provider details

- **NPI number:** 1386981561
- **Authorized official:** RONEL MCCOMBS (CREDENTIALING SPECIALIST)
- **Authorized official phone:** (502) 254-8500

## Contact information

- **Practice address:** 2600 CORNHUSKER DR, SOUTH SIOUX CITY, NE 68776-3905
- **Practice address phone:** (402) 494-2692
- **Practice address fax:** (402) 494-2701
- **Mailing address:** PO BOX 437169, LOUISVILLE, KY 40253-7169
- **Mailing address phone:** (502) 254-8500
- **Mailing address fax:** (502) 245-5021

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 01/09/2013
- **Last updated:** 01/09/2013