Provider Demographics
NPI:1063984508
Name:PARKVIEW PEDIATRIC DENTAL HOLDINGS, PLLC
Entity type:Organization
Organization Name:PARKVIEW PEDIATRIC DENTAL HOLDINGS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KERI
Authorized Official - Middle Name:
Authorized Official - Last Name:COLLINGSWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-796-2408
Mailing Address - Street 1:7515 QUAKER AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424-5315
Mailing Address - Country:US
Mailing Address - Phone:806-796-2408
Mailing Address - Fax:
Practice Address - Street 1:7515 QUAKER AVE STE 100
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-5315
Practice Address - Country:US
Practice Address - Phone:806-796-2408
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-21
Last Update Date:2018-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty