Provider Demographics
NPI:1952577611
Name:FAMILY FIRST DENTAL ASSOCIATES OF PRIMGHAR, P.C.
Entity type:Organization
Organization Name:FAMILY FIRST DENTAL ASSOCIATES OF PRIMGHAR, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:S
Authorized Official - Last Name:SKOGLUND
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:402-644-3177
Mailing Address - Street 1:217 W 6TH ST
Mailing Address - Street 2:
Mailing Address - City:STORM LAKE
Mailing Address - State:IA
Mailing Address - Zip Code:50588-1819
Mailing Address - Country:US
Mailing Address - Phone:712-732-2319
Mailing Address - Fax:
Practice Address - Street 1:217 W 6TH ST
Practice Address - Street 2:
Practice Address - City:STORM LAKE
Practice Address - State:IA
Practice Address - Zip Code:50588-1819
Practice Address - Country:US
Practice Address - Phone:712-732-2319
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-02
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty