Provider Demographics
NPI:1992248058
Name:PARKVIEW DENTAL
Entity type:Organization
Organization Name:PARKVIEW DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-535-7522
Mailing Address - Street 1:549 PARKVIEW DR
Mailing Address - Street 2:
Mailing Address - City:NEW WHITELAND
Mailing Address - State:IN
Mailing Address - Zip Code:46184-1365
Mailing Address - Country:US
Mailing Address - Phone:317-535-7522
Mailing Address - Fax:317-535-5115
Practice Address - Street 1:549 PARKVIEW DR.
Practice Address - Street 2:
Practice Address - City:NEW WHITELAND
Practice Address - State:IN
Practice Address - Zip Code:46184
Practice Address - Country:US
Practice Address - Phone:317-535-7522
Practice Address - Fax:317-535-5115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-22
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12011888A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty