Organization
BLACK HILLS EMBRACE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRIAN KELLY PROUTY DDS (OWNER)
(056) 878-0456
Entity
Organization
Contact information
Practice address
4215 BERNIECE ST, RAPID CITY, SD 57703-6410
(605) 343-6691
Mailing address
4215 BERNIECE ST, RAPID CITY, SD 57703-6410
(605) 343-6691
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Enumeration date
12/08/2020
Last updated
12/08/2020
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