Individual
ILYA MARCHENKO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
350 PINE ST, RAPID CITY, SD 57701-1669
(346) 757-7545
Mailing address
350 PINE ST, RAPID CITY, SD 57701-1669
(605) 721-8919
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D1407
SD
Other
Enumeration date
06/05/2023
Last updated
08/17/2023
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