Provider Demographics
NPI:1891067690
Name:FAMILY FIRST DENTAL ASSOCIATES OF PRIMGHAR, P.C.
Entity Type:Organization
Organization Name:FAMILY FIRST DENTAL ASSOCIATES OF PRIMGHAR, P.C.
Other - Org Name:FAMILY 1ST DENTAL OF PRIMGHAR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:S
Authorized Official - Last Name:SKOGLUND
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:402-644-3177
Mailing Address - Street 1:180 1ST ST NW
Mailing Address - Street 2:P.0. BOX 278
Mailing Address - City:PRIMGHAR
Mailing Address - State:IA
Mailing Address - Zip Code:51245-7700
Mailing Address - Country:US
Mailing Address - Phone:712-957-2460
Mailing Address - Fax:
Practice Address - Street 1:180 1ST ST NW
Practice Address - Street 2:
Practice Address - City:PRIMGHAR
Practice Address - State:IA
Practice Address - Zip Code:51245-7700
Practice Address - Country:US
Practice Address - Phone:712-957-2460
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-08
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty