Provider Demographics
NPI:1598296519
Name:KRALIK DENTAL CENTERS, PC
Entity Type:Organization
Organization Name:KRALIK DENTAL CENTERS, PC
Other - Org Name:FAMILY DENTAL CENTER OF MORNINGSIDE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LACY
Authorized Official - Middle Name:
Authorized Official - Last Name:CEDILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-276-4434
Mailing Address - Street 1:4016 MORNINGSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51106-2459
Mailing Address - Country:US
Mailing Address - Phone:712-276-4434
Mailing Address - Fax:712-276-4477
Practice Address - Street 1:4016 MORNINGSIDE AVE
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51106-2459
Practice Address - Country:US
Practice Address - Phone:712-276-4434
Practice Address - Fax:712-276-4477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-22
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA08784261QD0000X
IA08689261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental