Provider Demographics
NPI:1427864420
Name:ANKENY DENTAL ENTERPRISES LLC
Entity type:Organization
Organization Name:ANKENY DENTAL ENTERPRISES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHAUN
Authorized Official - Middle Name:
Authorized Official - Last Name:O'NEILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-289-2540
Mailing Address - Street 1:3020 AURORA AVE
Mailing Address - Street 2:
Mailing Address - City:SPIRIT LAKE
Mailing Address - State:IA
Mailing Address - Zip Code:51360-7097
Mailing Address - Country:US
Mailing Address - Phone:608-289-2540
Mailing Address - Fax:
Practice Address - Street 1:340 SE DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50021-9346
Practice Address - Country:US
Practice Address - Phone:712-336-2460
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:IOWA DENTAL ASSOCIATES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-12-05
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty