Organization
NORTHEAST ORTHODONTIC ASSOCIATES. L.L.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RYAN K VAN LAECKEN D.D.S., M.S. (OWNER)
(605) 882-2772
Entity
Organization
Contact information
Practice address
25 5TH ST NE, WATERTOWN, SD 57201-3712
(605) 882-1500
(605) 882-7090
Mailing address
25 5TH ST NE, P O BOX 1450, WATERTOWN, SD 57201-3712
(605) 882-1500
(605) 882-7090
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
M817
SD
Other
Enumeration date
08/21/2007
Last updated
08/21/2007
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