Ponderosa Smiles

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

PONDEROSA SMILES

Practice address

5955 Mount Rushmore Rd Ste a
Rapid City, SD 57701-8960

Phone

(605) 791-5005

NPI assigned

Oct 15, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Rob LyonsNPI 1134417058

Title

Dentist

Phone

(605) 791-5005

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Rob Dean Lyons, DDS

  • General Practice Dentistry
  • Rapid City, SD
  • NPI 1134417058
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1602720000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1602720000000",
    "number": "1053919506",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5955 MOUNT RUSHMORE RD STE A",
            "city": "RAPID CITY",
            "state": "SD",
            "postal_code": "577018960",
            "telephone_number": "605-791-5005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5955 MOUNT RUSHMORE RD STE A",
            "city": "RAPID CITY",
            "state": "SD",
            "postal_code": "577018960",
            "telephone_number": "605-791-5005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PONDEROSA SMILES",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-15",
        "last_updated": "2020-10-15",
        "certification_date": "2020-10-15",
        "status": "A",
        "authorized_official_last_name": "LYONS",
        "authorized_official_first_name": "ROB",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "605-791-5005"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Rapid City, SD
• Providers in Rapid City, SD by specialty
• General Practice Dentistry in South Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.