Provider Demographics
NPI:1881791002
Name:PARKVIEW DENTAL, LLC
Entity type:Organization
Organization Name:PARKVIEW DENTAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DMD
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:PUGEDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-281-1888
Mailing Address - Street 1:728 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:IL
Mailing Address - Zip Code:62236-2429
Mailing Address - Country:US
Mailing Address - Phone:618-281-1888
Mailing Address - Fax:618-281-1889
Practice Address - Street 1:728 S MAIN ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:IL
Practice Address - Zip Code:62236-2429
Practice Address - Country:US
Practice Address - Phone:618-281-1888
Practice Address - Fax:618-281-1889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019025365122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty