Provider Demographics
NPI:1326511189
Name:STILL WATERS FAMILY DENTISTRY, PC
Entity Type:Organization
Organization Name:STILL WATERS FAMILY DENTISTRY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CLARK
Authorized Official - Middle Name:
Authorized Official - Last Name:DOWNEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:260-622-4138
Mailing Address - Street 1:10045 NORTH STATE ROAD 1
Mailing Address - Street 2:
Mailing Address - City:OSSIAN
Mailing Address - State:IN
Mailing Address - Zip Code:46777
Mailing Address - Country:US
Mailing Address - Phone:260-622-4138
Mailing Address - Fax:
Practice Address - Street 1:10045 NORTH STATE ROAD 1
Practice Address - Street 2:
Practice Address - City:OSSIAN
Practice Address - State:IN
Practice Address - Zip Code:46777
Practice Address - Country:US
Practice Address - Phone:260-622-4138
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-04
Last Update Date:2019-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty