Provider Demographics
NPI:1457512840
Name:HAWKEYE FAMILY DENTAL
Entity type:Organization
Organization Name:HAWKEYE FAMILY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARCY
Authorized Official - Middle Name:LEE ZWART
Authorized Official - Last Name:REINEKE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:319-341-5868
Mailing Address - Street 1:1705 S 1ST AVE STE P
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52240-6037
Mailing Address - Country:US
Mailing Address - Phone:319-338-7172
Mailing Address - Fax:
Practice Address - Street 1:1705 S 1ST AVE STE P
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52240-6037
Practice Address - Country:US
Practice Address - Phone:319-338-7172
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-19
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1518150689Medicaid