Organization
ISD NATIONAL CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRIAN PROUTY DDS (OWNER)
(605) 275-2009
Entity
Organization
Contact information
Practice address
4320 S MINNESOTA AVE, SIOUX FALLS, SD 57105-6747
(605) 275-2009
(605) 884-9133
Mailing address
856 POMPESKA DR, WATERTOWN, SD 57201-5463
(605) 275-2009
(605) 884-9133
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
12/28/2023
Last updated
12/28/2023
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