Soderstrom Implant Dentistry, PC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

M537 Issued in SD

Legal business name

SODERSTROM IMPLANT DENTISTRY, PC

Practice address

907 Jackson Blvd
Rapid City, SD 57702-2541

Phone

(605) 388-0930

Fax

(605) 388-0929

NPI assigned

Apr 10, 2007

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Jerry L. Soderstrom, DDS

Title

President

Phone

(605) 388-0930

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1176163200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1083837199",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "907 JACKSON BLVD",
            "city": "RAPID CITY",
            "state": "SD",
            "postal_code": "577022541",
            "telephone_number": "605-388-0930",
            "fax_number": "605-388-0929"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "907 JACKSON BLVD",
            "city": "RAPID CITY",
            "state": "SD",
            "postal_code": "577022541",
            "telephone_number": "605-388-0930",
            "fax_number": "605-388-0929"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SODERSTROM IMPLANT DENTISTRY, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-10",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SODERSTROM",
        "authorized_official_first_name": "JERRY",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "605-388-0930",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "SD",
            "license": "M537",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.