Provider Demographics
NPI:1700363116
Name:FRANK SCOTT PARKWAY FAMILY DENTAL, LLC
Entity Type:Organization
Organization Name:FRANK SCOTT PARKWAY FAMILY DENTAL, LLC
Other - Org Name:FRANK SCOTT PARKWAY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:GUILBEAULT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:618-643-9523
Mailing Address - Street 1:1922 EDWARDSVILLE CLUB PLAZA CT
Mailing Address - Street 2:
Mailing Address - City:EDWARDSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62025-3717
Mailing Address - Country:US
Mailing Address - Phone:618-643-9523
Mailing Address - Fax:618-643-9523
Practice Address - Street 1:4933 BENCHMARK CENTRE DR STE A
Practice Address - Street 2:
Practice Address - City:SWANSEA
Practice Address - State:IL
Practice Address - Zip Code:62226-8927
Practice Address - Country:US
Practice Address - Phone:618-643-9523
Practice Address - Fax:618-643-9523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-27
Last Update Date:2018-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty