Organization
WISWALL ADAMS ENDODONTICS LLC
Active
Other names
Dakota Endodontics
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEFFREY WISWALL DDS, MS (PRESIDENT)
(605) 716-3546
Entity
Organization
Contact information
Practice address
2525 W MAIN ST STE 307, RAPID CITY, SD 57702-2443
(605) 716-3546
Mailing address
2525 W MAIN ST STE 206, RAPID CITY, SD 57702-2439
(605) 716-3546
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
M967
SD
Other
Enumeration date
09/17/2015
Last updated
09/17/2015
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