Organization
PONDEROSA SMILES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROB LYONS (DENTIST)
(605) 791-5005
Entity
Organization
Contact information
Practice address
5955 MOUNT RUSHMORE RD STE A, RAPID CITY, SD 57701-8960
(605) 791-5005
Mailing address
5955 MOUNT RUSHMORE RD STE A, RAPID CITY, SD 57701-8960
(605) 791-5005
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
10/15/2020
Last updated
10/15/2020
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