Provider Demographics
NPI:1699266965
Name:PARKVILLE PEDIATRIC DENTISTRY, LLC
Entity type:Organization
Organization Name:PARKVILLE PEDIATRIC DENTISTRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RACHAEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:GRAUE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:816-746-5437
Mailing Address - Street 1:6004 NW 9 HWY
Mailing Address - Street 2:
Mailing Address - City:PARKVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64152-3549
Mailing Address - Country:US
Mailing Address - Phone:816-746-5437
Mailing Address - Fax:
Practice Address - Street 1:6004 N.W. 9 HWY
Practice Address - Street 2:
Practice Address - City:PARKVILLE
Practice Address - State:MO
Practice Address - Zip Code:64152-3549
Practice Address - Country:US
Practice Address - Phone:816-746-5437
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-22
Last Update Date:2018-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty