Provider Demographics
NPI:1508187758
Name:SHOWALTER, INC
Entity Type:Organization
Organization Name:SHOWALTER, INC
Other - Org Name:ROCK RIVER DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:D
Authorized Official - Last Name:SHOWALTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-563-4415
Mailing Address - Street 1:1951 COMMERCE PKWY
Mailing Address - Street 2:
Mailing Address - City:FORT ATKINSON
Mailing Address - State:WI
Mailing Address - Zip Code:53538-3139
Mailing Address - Country:US
Mailing Address - Phone:920-563-4415
Mailing Address - Fax:920-563-4476
Practice Address - Street 1:1951 COMMERCE PKWY
Practice Address - Street 2:
Practice Address - City:FORT ATKINSON
Practice Address - State:WI
Practice Address - Zip Code:53538-3139
Practice Address - Country:US
Practice Address - Phone:920-563-4415
Practice Address - Fax:920-563-4476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-22
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty