Organization
CHEYENNE RIVER DENTAL CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TIFFANY L LARSON (CRST DENTAL ADMINISTRATIVE MANAGER)
(605) 964-0736
Entity
Organization
Contact information
Practice address
24276 166TH ST, EAGLE BUTTE, SD 57625-8141
(605) 964-0736
(605) 964-7800
Mailing address
PO BOX 590, EAGLE BUTTE, SD 57625-0590
(605) 964-0736
(605) 964-7800
Taxonomy
Speciality
Code
Description
License number
State
1223D0001X
Public Health Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5540240
—
SD
Enumeration date
03/07/2007
Last updated
08/05/2022
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