Provider Demographics
NPI:1487812582
Name:MONTICELLO FAMILY DENTISTRY, P.C.
Entity type:Organization
Organization Name:MONTICELLO FAMILY DENTISTRY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHELLY
Authorized Official - Middle Name:R
Authorized Official - Last Name:AITCHISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-465-3533
Mailing Address - Street 1:630 S MAIN ST
Mailing Address - Street 2:PO BOX 416
Mailing Address - City:MONTICELLO
Mailing Address - State:IA
Mailing Address - Zip Code:52310-1709
Mailing Address - Country:US
Mailing Address - Phone:319-465-3533
Mailing Address - Fax:319-465-4947
Practice Address - Street 1:630 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:IA
Practice Address - Zip Code:52310-1709
Practice Address - Country:US
Practice Address - Phone:319-465-3533
Practice Address - Fax:319-465-4947
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-27
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA072301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty