Implant & Sedation Dentistry LLC

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

IMPLANT & SEDATION DENTISTRY LLC

Practice address

3409 W 47TH St Ste 103
Sioux Falls, SD 57106-6339

Phone

(605) 275-2009

Fax

(605) 886-5209

NPI assigned

Mar 18, 2016

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) 275-2009

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1458259200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1458259200000",
    "number": "1588025514",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2300 9TH AVE SE",
            "city": "WATERTOWN",
            "state": "SD",
            "postal_code": "572017112",
            "telephone_number": "605-275-2009",
            "fax_number": "605-886-5209"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3409 W 47TH ST STE 103",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571066339",
            "telephone_number": "605-275-2009",
            "fax_number": "605-886-5209"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMPLANT & SEDATION DENTISTRY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-03-18",
        "last_updated": "2016-03-18",
        "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": "605-275-2009",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "SD",
            "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 Mar 18, 2016; 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.