Organization
PRAIRIE RIDGE ENDODONTICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL JOHN HAWLEY DDS (OWNER)
(605) 878-0180
Entity
Organization
Contact information
Practice address
600 4TH ST NE SUITE 101, WATERTOWN, SD 57201
(605) 878-0180
(605) 878-0181
Mailing address
600 4TH ST NE SUITE 101, WATERTOWN, SD 57201
(605) 878-0180
(605) 878-0181
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
D0515
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1891775904
TYPE 1 NPI
SD
Enumeration date
03/30/2016
Last updated
08/16/2019
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