Provider Demographics
NPI:1114071677
Name:PARK VIEW DENTAL ASSOC PC
Entity Type:Organization
Organization Name:PARK VIEW DENTAL ASSOC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:JOAN
Authorized Official - Last Name:SHAW
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:563-285-8566
Mailing Address - Street 1:5 A LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:ELDRIDGE
Mailing Address - State:IA
Mailing Address - Zip Code:52748-9699
Mailing Address - Country:US
Mailing Address - Phone:563-285-8566
Mailing Address - Fax:563-285-8567
Practice Address - Street 1:5 A LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:ELDRIDGE
Practice Address - State:IA
Practice Address - Zip Code:52748-9699
Practice Address - Country:US
Practice Address - Phone:563-285-8566
Practice Address - Fax:563-285-8567
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAIA06190122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty