Organization
SOUTH WESTERN DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THOMAS JAMES WEISBECKER DDS (PRESIDENT)
(605) 339-2200
Entity
Organization
Contact information
Practice address
5201 S WESTERN AVE, SIOUX FALLS, SD 57108-5004
(605) 339-2200
(605) 334-5530
Mailing address
5201 S WESTERN AVE, SIOUX FALLS, SD 57108-5004
(605) 339-2200
(605) 334-5530
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0937011
—
IA
05
—
7803400
—
SD
05
—
926228
—
MN
Enumeration date
10/11/2006
Last updated
08/22/2020
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