Provider Demographics
NPI:1386102465
Name:PARC VILLAGE DENTAL, LLC
Entity type:Organization
Organization Name:PARC VILLAGE DENTAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:HEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:920-336-6062
Mailing Address - Street 1:2805 LIBAL STREET, SUITE A
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54301
Mailing Address - Country:US
Mailing Address - Phone:920-336-6062
Mailing Address - Fax:920-336-9272
Practice Address - Street 1:2805 LIBAL STREET, SUITE A
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54301
Practice Address - Country:US
Practice Address - Phone:920-336-6062
Practice Address - Fax:920-336-9272
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PARC VILLAGE DENTAL, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-03-07
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty