Individual provider Active NPI

Collin C Palmquist, D.D.S.

  • Dentist
  • Watertown, SD
National Provider Identifier
1285757658
Registry record updated Dec 21, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
D0609 Issued in SD
Practice address
2702 8TH Ave SE
Watertown, SD 57201-9138
Phone
(605) 886-8096
Fax
(605) 886-1979
NPI assigned
Apr 9, 2007
Last updated
Dec 21, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 21, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X D0609 SD Primary

Addresses

Primary practice location

2702 8TH Ave SE
Watertown, SD 57201-9138

Mailing address

2702 8TH Ave SE
Watertown, SD 57201-9138
Phone (605) 886-8096

Other identifiers 1

IdentifierTypeStateIssuer
7809990MedicaidSD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SD
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160120000358 SD Order and Referring Only - DentistPractitioner - Dentist 5294038659

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
D0609SDMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Collin C. Palmquist DDS, PC General Practice Current Accepting new patients
F. Herbert Wiswall, D.D.S., P.C. General Practice Past Accepting new patients

Locations

600 4th St NE
Ste 201
Watertown, SD 57201
Phone (605) 886-8096

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1176076800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1703116800000",
    "number": "1285757658",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2702 8TH AVE SE",
            "city": "WATERTOWN",
            "state": "SD",
            "postal_code": "572019138",
            "telephone_number": "605-886-8096",
            "fax_number": "605-886-1979"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2702 8TH AVE SE",
            "city": "WATERTOWN",
            "state": "SD",
            "postal_code": "572019138",
            "telephone_number": "605-886-8096",
            "fax_number": "605-886-1979"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PALMQUIST",
        "first_name": "COLLIN",
        "middle_name": "C",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-09",
        "last_updated": "2023-12-21",
        "certification_date": "2023-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "SD",
            "license": "D0609",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7809990",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Watertown, SD

Sources for this page

Verify at the official NPI Registry.