Infinity Implant and Sedation Dentistry Black Hills LLC

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

INFINITY IMPLANT AND SEDATION DENTISTRY BLACK HILLS LLC

Practice address

4215 Berniece St
Rapid City, SD 57703-6410

Phone

(605) 343-6691

NPI assigned

Dec 8, 2020

Organization subpart

No

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

Authorized official

Name

Brian Kelly Prouty, DDS

Title

Owner

Phone

(605) 878-0456

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1607385600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1607385600000",
    "number": "1578169264",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4215 BERNIECE ST",
            "city": "RAPID CITY",
            "state": "SD",
            "postal_code": "577036410",
            "telephone_number": "605-343-6691"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4215 BERNIECE ST",
            "city": "RAPID CITY",
            "state": "SD",
            "postal_code": "577036410",
            "telephone_number": "605-343-6691"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INFINITY IMPLANT AND SEDATION DENTISTRY BLACK HILLS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-12-08",
        "last_updated": "2020-12-08",
        "certification_date": "2020-12-08",
        "status": "A",
        "authorized_official_last_name": "PROUTY",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "KELLY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "605-878-0456",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2020; 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.