Provider Demographics
NPI:1770040818
Name:LAWHEAD FAMILY DENTISTRY
Entity type:Organization
Organization Name:LAWHEAD FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE SUPPORT
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:S
Authorized Official - Last Name:ODEGARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-263-8034
Mailing Address - Street 1:315 SYCAMORE ST
Mailing Address - Street 2:
Mailing Address - City:MUSCATINE
Mailing Address - State:IA
Mailing Address - Zip Code:52761-3824
Mailing Address - Country:US
Mailing Address - Phone:563-263-8034
Mailing Address - Fax:563-288-1653
Practice Address - Street 1:315 SYCAMORE ST
Practice Address - Street 2:
Practice Address - City:MUSCATINE
Practice Address - State:IA
Practice Address - Zip Code:52761-3824
Practice Address - Country:US
Practice Address - Phone:563-263-8034
Practice Address - Fax:563-288-1653
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-25
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty