Provider Demographics
NPI:1275965246
Name:REVELL-WARRINGTON DENTAL PC
Entity Type:Organization
Organization Name:REVELL-WARRINGTON DENTAL PC
Other - Org Name:DES MOINES CHILDREN'S DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JACK
Authorized Official - Middle Name:
Authorized Official - Last Name:WARRINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:515-225-1677
Mailing Address - Street 1:5950 VILLAGE VIEW DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-3844
Mailing Address - Country:US
Mailing Address - Phone:515-225-1677
Mailing Address - Fax:
Practice Address - Street 1:5950 VILLAGE VIEW DR
Practice Address - Street 2:SUITE 200
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-3844
Practice Address - Country:US
Practice Address - Phone:515-225-1677
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-01
Last Update Date:2014-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA086311223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty