Provider Demographics
NPI:1386206969
Name:HEALTHY SMILES FAMILY DENTISTRY, PC
Entity Type:Organization
Organization Name:HEALTHY SMILES FAMILY DENTISTRY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER /DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:GENERAL
Authorized Official - Last Name:WADDEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:563-263-0017
Mailing Address - Street 1:1616 YOUNG AVE
Mailing Address - Street 2:
Mailing Address - City:MUSCATINE
Mailing Address - State:IA
Mailing Address - Zip Code:52761-3435
Mailing Address - Country:US
Mailing Address - Phone:563-263-0017
Mailing Address - Fax:
Practice Address - Street 1:1616 YOUNG AVE
Practice Address - Street 2:
Practice Address - City:MUSCATINE
Practice Address - State:IA
Practice Address - Zip Code:52761-3435
Practice Address - Country:US
Practice Address - Phone:563-263-0017
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-03
Last Update Date:2019-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental