Individual
DR. DOUGLAS E IDEMA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
2521 S WESTERN AVE, SIOUX FALLS, SD 57105
(605) 336-1967
(605) 731-1860
Mailing address
2521 S WESTERN AVE, SIOUX FALLS, SD 57105
(605) 336-1967
(605) 731-1860
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
M266
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7800750
—
SD
Enumeration date
11/22/2006
Last updated
07/08/2007
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