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Organization
CLEAR LAKE DENTAL LLC
Active
Organization
CLEAR LAKE DENTAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRIAN KELLY PROUTY DDS (OWNER)
(605) 874-2230
Entity
Organization
Contact information
Practice address
210 3RD AVE SOUTH, CLEAR LAKE, SD 57226
(605) 874-2230
(605) 874-2675
Mailing address
210 3RD AVE SOUTH, CLEAR LAKE, SD 57226
(605) 874-2230
(604) 874-2675
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
02/09/2016
Last updated
02/09/2016
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