Black Hills Embrace LLC

Organization Active NPI Dentist · Rapid City, SD

NPI 1134725922 · NPPES record last updated Dec 8, 2020

Key facts

NPI
1134725922
Entity type
Organization (NPI type 2)
Primary specialty
Dentist 122300000X
Legal business name
BLACK HILLS EMBRACE LLC
Practice address
4215 Berniece St
Rapid City, SD 57703-6410
Phone
(605) 343-6691
NPI assigned
Dec 8, 2020
Organization subpart
No

Authorized official

Name
Brian Kelly Prouty, DDS
Title
Owner
Phone
(056) 878-0456

National Provider Directory

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist
Group: 193400000X SINGLE SPECIALTY GROUP
122300000X Yes

Addresses

Primary practice location

4215 Berniece St
Rapid City, SD 57703-6410

Mailing address

4215 Berniece St
Rapid City, SD 57703-6410
Phone (605) 343-6691

Other providers in Rapid City, SD

All providers in Rapid City, SD · Dentist in South Dakota

Sources for this page

Verify at the official NPI Registry.