Provider Demographics
NPI:1487253068
Name:WRIGHT COUNTY FAMILY DENTAL
Entity type:Organization
Organization Name:WRIGHT COUNTY FAMILY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:MAUREEN STILLMAN
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:402-990-4464
Mailing Address - Street 1:517 MAPLE LN
Mailing Address - Street 2:
Mailing Address - City:CLARION
Mailing Address - State:IA
Mailing Address - Zip Code:50525-1237
Mailing Address - Country:US
Mailing Address - Phone:402-990-4464
Mailing Address - Fax:
Practice Address - Street 1:1403 CENTRAL AVE W
Practice Address - Street 2:
Practice Address - City:CLARION
Practice Address - State:IA
Practice Address - Zip Code:50525-7707
Practice Address - Country:US
Practice Address - Phone:402-990-4464
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-23
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1366859993OtherDENTIST