Provider Demographics
NPI:1821256983
Name:ASPEN DENTAL PARKSIDE PC
Entity Type:Organization
Organization Name:ASPEN DENTAL PARKSIDE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:KNOP
Authorized Official - Suffix:II
Authorized Official - Credentials:DDS
Authorized Official - Phone:765-447-2456
Mailing Address - Street 1:2122 SCOTT ST
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47904-2932
Mailing Address - Country:US
Mailing Address - Phone:765-447-2456
Mailing Address - Fax:765-449-1356
Practice Address - Street 1:2122 SCOTT ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47904-2932
Practice Address - Country:US
Practice Address - Phone:765-447-2456
Practice Address - Fax:765-449-1356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-27
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental