Healthcare Provider Details

I. General information

NPI: 1306968953
Provider Name (Legal Business Name): NORTHPARK FAMILY DENTISTRY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 01/04/2024
Certification Date: 01/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 13TH ST N STE 1
HUMBOLDT IA
50548-1129
US

IV. Provider business mailing address

1101 13TH ST N STE 1
HUMBOLDT IA
50548-1129
US

V. Phone/Fax

Practice location:
  • Phone: 515-332-3230
  • Fax:
Mailing address:
  • Phone: 515-332-3230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: GRACE SCHOLL
Title or Position: OFFICE MANAGER
Credential:
Phone: 515-332-3230