Provider Demographics
NPI:1902209976
Name:CENTER POINT FAMILY DENTISTRY PLLC
Entity Type:Organization
Organization Name:CENTER POINT FAMILY DENTISTRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRA
Authorized Official - Middle Name:KATHLEEN
Authorized Official - Last Name:HICKEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:319-849-1171
Mailing Address - Street 1:907 BANK COURT
Mailing Address - Street 2:
Mailing Address - City:CENTER POINT
Mailing Address - State:IA
Mailing Address - Zip Code:52213-9337
Mailing Address - Country:US
Mailing Address - Phone:319-849-1171
Mailing Address - Fax:319-849-2453
Practice Address - Street 1:907 BANK COURT
Practice Address - Street 2:
Practice Address - City:CENTER POINT
Practice Address - State:IA
Practice Address - Zip Code:52213-9337
Practice Address - Country:US
Practice Address - Phone:319-849-1171
Practice Address - Fax:319-849-2453
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-03
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty