Provider Demographics
NPI:1639511876
Name:PLANK FAMILY DENTAL CENTER
Entity Type:Organization
Organization Name:PLANK FAMILY DENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:TROYER
Authorized Official - Last Name:PLANK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:319-338-9761
Mailing Address - Street 1:1700 S 1ST AVE STE 29
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52240-6036
Mailing Address - Country:US
Mailing Address - Phone:319-338-9761
Mailing Address - Fax:319-341-6086
Practice Address - Street 1:1700 S 1ST AVE STE 29
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52240-6036
Practice Address - Country:US
Practice Address - Phone:319-338-9761
Practice Address - Fax:319-341-6086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-29
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA08843261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental