NPIMap

Organization Active NPI

Motz DDS PC

Doing business as Prairie Dental Center

  • Dentist
  • Sioux Falls, SD
National Provider Identifier
1922196955
Registry record updated Sep 25, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
M631 Issued in SD
Legal business name
MOTZ DDS PC
Doing business as
Prairie Dental Center
Practice address
4904 S Minnesota Ave
Sioux Falls, SD 57108-2864
Phone
(605) 335-8640
Fax
(605) 332-9956
NPI assigned
Oct 11, 2006
Last updated
Sep 25, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 25, 2014

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

Authorized official

Name
Dr. Justin M. Nichols, DDSNPI 1881783595
Title
Dentist/Owner
Phone
(605) 335-8640

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X D0522 SD
Dentist 122300000X D1051 SD
Dentist 122300000X M631 SD Primary

Addresses

Primary practice location

4904 S Minnesota Ave
Sioux Falls, SD 57108-2864

Mailing address

4904 S Minnesota Ave
Sioux Falls, SD 57108-2864
Phone (605) 335-8640

Other identifiers 3

IdentifierTypeStateIssuer
D0522OtherSDSTATE LICENSE NUMBER
D1051OtherSDSTATE LICENSE NUMBER
M631OtherSDSTATE LICENSE NUMBER

Other names 1

  • Prairie Dental Center Doing business as

National Provider Directory

National Provider Directory

Locations

4904 S Minnesota Ave
Sioux Falls, SD 57108
Phone (605) 335-8640

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": "1160524800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1411603200000",
    "number": "1922196955",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4904 S MINNESOTA AVE",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571082864",
            "telephone_number": "605-335-8640",
            "fax_number": "605-332-9956"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4904 S MINNESOTA AVE",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571082864",
            "telephone_number": "605-335-8640",
            "fax_number": "605-332-9956"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOTZ DDS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-11",
        "last_updated": "2014-09-25",
        "status": "A",
        "authorized_official_last_name": "NICHOLS",
        "authorized_official_first_name": "JUSTIN",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "DENTIST/OWNER",
        "authorized_official_telephone_number": "605-335-8640",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "SD",
            "license": "D0522",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "SD",
            "license": "D1051",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "SD",
            "license": "M631",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE NUMBER",
            "identifier": "D0522",
            "state": "SD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE NUMBER",
            "identifier": "D1051",
            "state": "SD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE NUMBER",
            "identifier": "M631",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Prairie Dental Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sioux Falls, SD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2014; 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.