Provider Demographics
NPI:1053837690
Name:CHILDREN'S DENTAL CENTRE, PC
Entity Type:Organization
Organization Name:CHILDREN'S DENTAL CENTRE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KAITLIN
Authorized Official - Middle Name:JOY
Authorized Official - Last Name:HOOGEVEEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:712-441-2807
Mailing Address - Street 1:PO BOX 228
Mailing Address - Street 2:
Mailing Address - City:SIOUX CENTER
Mailing Address - State:IA
Mailing Address - Zip Code:51250-0228
Mailing Address - Country:US
Mailing Address - Phone:712-722-5565
Mailing Address - Fax:712-722-5566
Practice Address - Street 1:164 S MAIN AVE
Practice Address - Street 2:
Practice Address - City:SIOUX CENTER
Practice Address - State:IA
Practice Address - Zip Code:51250-1536
Practice Address - Country:US
Practice Address - Phone:712-722-5565
Practice Address - Fax:712-722-5566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-15
Last Update Date:2017-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IADDS-093731223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty