Provider Demographics
NPI:1134298631
Name:FRANKLIN COUNTY DENTAL NETWORK
Entity Type:Organization
Organization Name:FRANKLIN COUNTY DENTAL NETWORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:GREG
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:ROEBACK
Authorized Official - Suffix:
Authorized Official - Credentials:MA, NCC, LPC
Authorized Official - Phone:636-239-1717
Mailing Address - Street 1:104 S MCKINLEY AVE
Mailing Address - Street 2:SUITE E
Mailing Address - City:UNION
Mailing Address - State:MO
Mailing Address - Zip Code:63084-1800
Mailing Address - Country:US
Mailing Address - Phone:636-239-8397
Mailing Address - Fax:363-390-7379
Practice Address - Street 1:851 E 5TH ST
Practice Address - Street 2:SUITE 131
Practice Address - City:WASHINGTON
Practice Address - State:MO
Practice Address - Zip Code:63090-3135
Practice Address - Country:US
Practice Address - Phone:636-239-8397
Practice Address - Fax:636-390-7379
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty