Provider Demographics
NPI:1013183789
Name:FAMILY FIRST DENTAL ASSOCIATES OF SAC CITY, P.C.
Entity Type:Organization
Organization Name:FAMILY FIRST DENTAL ASSOCIATES OF SAC CITY, P.C.
Other - Org Name:FAMILY 1ST DENTAL OF LAKE VIEW
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:S
Authorized Official - Last Name:SKOGLUND
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:402-644-3177
Mailing Address - Street 1:1160 3RD ST
Mailing Address - Street 2:
Mailing Address - City:LAKE VIEW
Mailing Address - State:IA
Mailing Address - Zip Code:51450-7612
Mailing Address - Country:US
Mailing Address - Phone:712-657-3061
Mailing Address - Fax:
Practice Address - Street 1:1160 3RD ST
Practice Address - Street 2:
Practice Address - City:LAKE VIEW
Practice Address - State:IA
Practice Address - Zip Code:51450-7612
Practice Address - Country:US
Practice Address - Phone:712-657-3061
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-02
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty