Organization
MODERN DENTAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHRIS DIAZ-FREED DDS (OWNER)
(605) 261-4697
Entity
Organization
Contact information
Practice address
5912 E 18 STREET, SIOUX FALLS, SD 57110
(605) 261-4697
Mailing address
8604 S QUIET OAK CIR, SIOUX FALLS, SD 57108-4138
(605) 261-4697
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1275784605
—
SD
05
—
1710141726
—
SD
Enumeration date
10/22/2025
Last updated
10/22/2025
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