NPIMap

Organization Active NPI

Preventative Dental LLC

  • Dentist
  • Watertown, SD
National Provider Identifier
1225417355
Registry record updated May 21, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
M983 Issued in SD
Legal business name
PREVENTATIVE DENTAL LLC
Practice address
1155 4TH St NE
Watertown, SD 57201-1202
Phone
(605) 882-3060
Fax
(605) 882-0681
NPI assigned
May 21, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 21, 2015

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

Authorized official

Name
Jeanne Myers
Title
Office Manager
Phone
(605) 868-2191

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X M983 SD Primary

Addresses

Primary practice location

1155 4TH St NE
Watertown, SD 57201-1202

Mailing address

1155 4TH St NE
Watertown, SD 57201-1202
Phone (605) 882-3060

National Provider Directory

National Provider Directory

Locations

1155 4th St NE
Watertown, SD 57201
Phone (605) 882-3060

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1432166400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1432166400000",
    "number": "1225417355",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1155 4TH ST NE",
            "city": "WATERTOWN",
            "state": "SD",
            "postal_code": "572011202",
            "telephone_number": "605-882-3060",
            "fax_number": "605-882-0681"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1155 4TH ST NE",
            "city": "WATERTOWN",
            "state": "SD",
            "postal_code": "572011202",
            "telephone_number": "605-882-3060",
            "fax_number": "605-882-0681"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREVENTATIVE DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-05-21",
        "last_updated": "2015-05-21",
        "status": "A",
        "authorized_official_last_name": "MYERS",
        "authorized_official_first_name": "JEANNE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "605-868-2191"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "SD",
            "license": "M983",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Watertown, SD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2015; 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.