Lamar Wilbur Koistinen, DDS
Individual provider Active NPI Dentist · Desmet, SD
NPI 1134567746 · NPPES record last updated Jun 30, 2014
Key facts
- NPI
- 1134567746
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 413 (SD)
- Practice address
- 401 Prairie Ave SW
Desmet, SD 57231 - Phone
- (605) 854-3455
- Fax
- (605) 854-9952
- NPI assigned
- Jun 6, 2013
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 413 | SD | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Horizon Health Care Inc | Past | Accepting new patients | |
| Horizon Health Care Inc | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 413 | SD | Yes |
Addresses
Primary practice location
401 Prairie Ave SW
Desmet, SD 57231
Mailing address
401 Prairie Ave SW
PO Box 49
Desmet, SD 57231
Phone (605) 854-3455
Other providers in Desmet, SD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 30, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.