Provider Demographics
NPI:1952401770
Name:ARROWHEAD DENTAL CENTER,SC
Entity type:Organization
Organization Name:ARROWHEAD DENTAL CENTER,SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:COREY
Authorized Official - Middle Name:C
Authorized Official - Last Name:DIKE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:715-252-7777
Mailing Address - Street 1:2906 POST RD
Mailing Address - Street 2:
Mailing Address - City:STEVENS POINT
Mailing Address - State:WI
Mailing Address - Zip Code:54481-6417
Mailing Address - Country:US
Mailing Address - Phone:715-345-7770
Mailing Address - Fax:715-345-9808
Practice Address - Street 1:2906 POST RD
Practice Address - Street 2:
Practice Address - City:STEVENS POINT
Practice Address - State:WI
Practice Address - Zip Code:54481-6417
Practice Address - Country:US
Practice Address - Phone:715-345-7770
Practice Address - Fax:715-345-9808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5001601-015261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI=========OtherSERVICE CORPORATION