Organization
MOTZ DDS PC
Active
Other names
Prairie Dental Center
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JUSTIN M. NICHOLS DDS (DENTIST/OWNER)
(605) 335-8640
Entity
Organization
Contact information
Practice address
4904 S MINNESOTA AVE, SIOUX FALLS, SD 57108-2864
(605) 335-8640
(605) 332-9956
Mailing address
4904 S MINNESOTA AVE, SIOUX FALLS, SD 57108-2864
(605) 335-8640
(605) 332-9956
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
D0522
SD
122300000X
Dentist
D1051
SD
122300000X
Dentist
Primary
M631
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
D0522
STATE LICENSE NUMBER
SD
01
—
D1051
STATE LICENSE NUMBER
SD
01
—
M631
STATE LICENSE NUMBER
SD
Enumeration date
10/11/2006
Last updated
09/25/2014
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