Provider Demographics
NPI:1174500813
Name:VILLAGE FAMILY DENTAL ASSCOCIATES
Entity Type:Organization
Organization Name:VILLAGE FAMILY DENTAL ASSCOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF CORPORATION
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:F
Authorized Official - Last Name:PEEPLES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:608-643-8505
Mailing Address - Street 1:1209 MILLS ST
Mailing Address - Street 2:
Mailing Address - City:BLACK EARTH
Mailing Address - State:WI
Mailing Address - Zip Code:53515-9420
Mailing Address - Country:US
Mailing Address - Phone:608-767-3604
Mailing Address - Fax:608-767-3606
Practice Address - Street 1:1209 MILLS ST
Practice Address - Street 2:
Practice Address - City:BLACK EARTH
Practice Address - State:WI
Practice Address - Zip Code:53515-9420
Practice Address - Country:US
Practice Address - Phone:608-767-3604
Practice Address - Fax:608-767-3606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty