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General NPI Number Information
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NPI Number | 1174797310
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Entity Type | Organization
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Legal Business Name | WESTOWN PARKWAY DENTAL AFFILIATES, PC
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Dates
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Enumeration Date | 04/18/2008
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Last Update Date | 04/18/2008
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Provider Practice Location Address
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Address Line | 2375 BERKSHIRE PKWY
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City | CLIVE
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State | IA
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Zip | 50325-4677
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Country | US
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Telephone | 515-987-7670
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Fax | 515-987-7671
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Provider Business Mailing Address
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Address Line | 2375 BERKSHIRE PKWY
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City | CLIVE
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State | IA
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Zip | 50325-4677
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Country | US
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Telephone | 515-987-7670
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Fax | 515-987-7671
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Authorized Official
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Title or Position | PARTNER
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Name | DR. STEPHEN FORREST
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Credential | DDS
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Telephone | 515-987-7670
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 7057
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License Number State | IA
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