Provider Demographics
NPI:1942618590
Name:PARKWAY DENTAL GROUP PLLC
Entity Type:Organization
Organization Name:PARKWAY DENTAL GROUP PLLC
Other - Org Name:ISMILE AT PARKWAY DENTAL LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRITNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-256-6167
Mailing Address - Street 1:1404 SUNRIVER PKWY STE 125
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-4824
Mailing Address - Country:US
Mailing Address - Phone:435-256-6167
Mailing Address - Fax:
Practice Address - Street 1:1404 SUNRIVER PKWY STE 125
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790
Practice Address - Country:US
Practice Address - Phone:435-256-6167
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-28
Last Update Date:2018-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty