Provider Demographics
NPI:1679620520
Name:CARROLL DENTAL CLINIC P.L.C.
Entity Type:Organization
Organization Name:CARROLL DENTAL CLINIC P.L.C.
Other - Org Name:LAKE VIEW FAMILY DENTISTRY & MANILLA FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:BOGUE P.C.
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:712-792-4375
Mailing Address - Street 1:703 SIMON AVE
Mailing Address - Street 2:PO BOX 997
Mailing Address - City:CARROLL
Mailing Address - State:IA
Mailing Address - Zip Code:51401-2264
Mailing Address - Country:US
Mailing Address - Phone:712-792-4375
Mailing Address - Fax:712-792-3371
Practice Address - Street 1:703 SIMON AVE
Practice Address - Street 2:
Practice Address - City:CARROLL
Practice Address - State:IA
Practice Address - Zip Code:51401-2264
Practice Address - Country:US
Practice Address - Phone:712-792-4375
Practice Address - Fax:712-792-3371
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2015-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty