Scott D Van Dam, DDS, MD

Primary specialty

Oral & Maxillofacial Surgery (D.M.D.)Taxonomy code 204E00000X

License

7080 Issued in SD

Practice address

3415 5TH St
Rapid City, SD 57701-7365

Phone

(605) 348-6818

NPI assigned

Jan 19, 2006

Last updated

Nov 28, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Mar 22, 2018 through Mar 22, 2028

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1137628800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1196208000000",
    "number": "1407836992",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3415 5TH ST",
            "city": "RAPID CITY",
            "state": "SD",
            "postal_code": "577017365",
            "telephone_number": "605-348-6818"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3415 5TH ST",
            "city": "RAPID CITY",
            "state": "SD",
            "postal_code": "577017365",
            "telephone_number": "605-348-6818"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAN DAM",
        "first_name": "SCOTT",
        "middle_name": "D",
        "credential": "DDS, MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-19",
        "last_updated": "2007-11-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "SD",
            "license": "7080",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8000530",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Jennifer Valencia
• Cynthia Ann Vallette I, ACT
• Cristian Jeremiah Van Dyke, DPT
• Leslie Adajar Van Dyne, MD
• Jacqueline Van Egeraat, M.D.
• Kimberly Sue Van Loan, MS, OTR/L, CLT
• Caroline Van Pelt

• Oral & Maxillofacial Surgery (D.M.D.) in Rapid City, SD
• Providers in Rapid City, SD by specialty
• Oral & Maxillofacial Surgery (D.M.D.) in South Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.