Organization
ADVANCED DERMATOLOGY CENTER, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SHEILA ODAY BODDICKER (OFFICE MANAGER)
(605) 343-8000
Entity
Organization
Contact information
Practice address
710 SAINT ANNE STREET, RAPID CITY, SD 57701
(605) 343-8000
(605) 343-8262
Mailing address
PO BOX 3468, RAPID CITY, SD 57709-3468
(605) 343-8000
(605) 343-8262
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
0329
SD
207N00000X
Dermatology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0006246
BLUE CROSS
SC
Enumeration date
02/06/2007
Last updated
02/13/2018
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