Provider Demographics
NPI:1700053055
Name:SKYWALK DENTAL OFFICE
Entity Type:Organization
Organization Name:SKYWALK DENTAL OFFICE
Other - Org Name:DAVID C COLLIER, DDS
Other - Org Type:Other Name
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:C
Authorized Official - Last Name:COLLIER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:515-280-3030
Mailing Address - Street 1:612 LOCUST ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50309-3718
Mailing Address - Country:US
Mailing Address - Phone:515-280-3030
Mailing Address - Fax:515-280-3426
Practice Address - Street 1:612 LOCUST ST
Practice Address - Street 2:SUITE 2
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-3718
Practice Address - Country:US
Practice Address - Phone:515-280-3030
Practice Address - Fax:515-280-3426
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-14
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA6370122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0159525Medicaid
IA6370 IAOtherSTATE OF IOWA LICENSE #