Provider Demographics
NPI:1528232527
Name:PARKWAY DENTAL, P.C.
Entity Type:Organization
Organization Name:PARKWAY DENTAL, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:517-349-3040
Mailing Address - Street 1:2277 SCIENCE PKWY
Mailing Address - Street 2:SUITE 1
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864-2551
Mailing Address - Country:US
Mailing Address - Phone:517-349-3040
Mailing Address - Fax:517-349-4416
Practice Address - Street 1:2277 SCIENCE PKWY
Practice Address - Street 2:SUITE 1
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-2551
Practice Address - Country:US
Practice Address - Phone:517-349-3040
Practice Address - Fax:517-349-4416
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-22
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010155941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty