MOODY DENTAL IMPLANT CENTERS LLC (NPI# 1649556978) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1649556978 |
| Entity Type | Organization |
| Organization Name | MOODY DENTAL IMPLANT CENTERS LLC |
| Other Organization Name | THE DENTAL IMPLANT CENTER |
| Practice Address |
705 Columbus St Rapid City SD 57701-3623 |
| Practice Telephone | 6057165622 |
| Practice Fax Number | 6057912982 |
| Mailing Telephone | 6057165622 |
| Mailing Fax Number | 6057912982 |
| Enumeration Date | 2011-11-01 |
| Last Update Date | 2016-09-22 |
| Authorized Official Name | JUSTIN D MOODY (OWNER) |
| Authorized Official Telephone | 6057165622 |
| Authorized Official Credential | DDS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223G0001X |
Dentist Specialization: General Practice |
M881 | SD | Dental Providers |
| Other Name | Type Code |
|---|---|
| The Dental Implant Center | Other Name - Individual/Organization |
| Street Address |
705 COLUMBUS ST |
| City | RAPID CITY |
| State | SD |
| Zip Code | 57701-3623 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528623345 | Julie Maas | Counselor | 625 1/2 Main St, Suite 1, Rapid City, SD 57701 | 2019-05-07 |
| 1972076024 | Edgewood Rapid City LLC | Assisted Living Facility | 4001 Derby Lane, Rapid City, SD 57701 | 2019-01-10 |
| 1902300247 | Theresa Gibbens | Speech-Language Pathologist | 3301 Grandview Drive, Rapid City, SD 57701 | 2018-03-21 |
| 1407355423 | Arielle Leigh Loveridge | Chiropractor | 610 East Boulevard, Suite 1, Rapid City, SD 57701 | 2018-02-05 |
| 1083125082 | Sarah Kirschman | Nurse Practitioner | 353 Fairmont Boulvevard, Rapid City, SD 57701 | 2017-10-17 |
| 1992225239 | Kelsey Elizabeth Wondercheck | Dentist | 717 Meade Street, Suite 200, Rapid City, SD 57701 | 2017-06-27 |
| 1316476088 | Rhianna Wickett | Physical Therapist | 420 E Saint Patrick St Ste 101, Rapid City, SD 57701 | 2017-06-07 |
| 1841727773 | Cynthia A Gates | Dietitian, Registered | 2908 5th Street, Rapid City, SD 57701 | 2017-05-23 |
| 1811447758 | Alyssa Marquardt | Psychologist | 433 Mt. Rushmore Road, Rapid City, SD 57701 | 2016-10-04 |
| 1578913232 | .indian Health Service | Clinic/Center | 241 East Meade St, Rapid City, SD 57701 | 2016-06-14 |
| Find all providers in zip 57701 | ||||
| Taxonomy Code | 1223G0001X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | General Practice |
| A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. |
| Notes: Source: Academy of General Dentistry |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134727969 | Shaun Lemmon | Dentist | 333 West Blvd # 300a, Rapid City, SD 57701-2670 | 2020-10-14 |
| 1366049660 | Byrne Dental, Professional LLC | Dentist | 3825 Canyon Lake Dr, Rapid City, SD 57702 | 2020-10-08 |
| 1376197533 | Richard Brady Perdue | Dentist | 2606 Elderberry Blvd, Rapid City, SD 57703 | 2019-07-26 |
| 1508424680 | Joshua Petersen | Dentist | 1687 Tablerock Rd, Rapid City, SD 57701-5495 | 2019-06-03 |
| 1063904290 | Brittni Rose Reichert | Dentist | 6005 Mount Rushmore Rd, Rapid City, SD 57701-8962 | 2018-06-04 |
| 1598279028 | Schmalz Dental LLC | Dentist | 1147 Eglin St, Rapid City, SD 57701-9612 | 2017-11-20 |
| 1134417058 | Rob Dean Lyons | Dentist | 5955 Mount Rushmore Rd Ste A, Rapid City, SD 57701 | 2011-07-12 |
| 1083852826 | Tracy Krafthefer Heeter | Dentist | 685 N Lacrosse St, Rapid City, SD 57701-1492 | 2009-02-02 |
| 1568611374 | Charles F. Scanlon II | Dentist | 5955 South Highway 16, Suite A, Rapid City, SD 57701-8911 | 2008-09-17 |
| 1336300847 | Eric Grant Unkenholz | Dentist | 710 Mount Rushmore Rd, Rapid City, SD 57701-3609 | 2008-06-18 |
| Find all providers in RAPID CITY | ||||
| City | RAPID CITY |
| Zip Code | 57701 |
Please comment or provide details below to improve the information on MOODY DENTAL IMPLANT CENTERS LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.