Organization
PREMIER ENDODONTICS, PC
Active
Other names
Summit Endodontics
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STEVEN FREDERICK WISWALL DMD, MS (PRESIDENT)
(605) 868-6422
Entity
Organization
Contact information
Practice address
703 QUINCY ST STE 2, RAPID CITY, SD 57701-3674
(605) 868-6422
Mailing address
13170 BRIDGE LN, RAPID CITY, SD 57702-8523
(605) 868-6422
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
—
—
Other
Enumeration date
01/30/2023
Last updated
01/30/2023
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