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Individual

ROSS DEAN LITTLE DOG

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
3200 CANYON LAKE DR, RAPID CITY, SD 57702-8114
(605) 355-2213
Mailing address
3200 CANYON LAKE DR, RAPID CITY, SD 57702-8114
(605) 355-2213

Taxonomy

Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0140070
SD
05
5549050
SD
Enumeration date
01/15/2010
Last updated
01/15/2010
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