Individual
SCOTT D VAN DAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS, MD
Contact information
Practice address
3415 5TH ST, RAPID CITY, SD 57701-7365
(605) 348-6818
Mailing address
3415 5TH ST, RAPID CITY, SD 57701-7365
(605) 348-6818
Taxonomy
Speciality
Code
Description
License number
State
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
7080
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8000530
—
SD
Enumeration date
01/19/2006
Last updated
11/28/2007
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