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General NPI Number Information
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NPI Number | 1881791002
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Entity Type | Organization
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Legal Business Name | PARKVIEW DENTAL, LLC
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 02/07/2017
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Provider Practice Location Address
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Address Line | 728 S MAIN ST
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City | COLUMBIA
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State | IL
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Zip | 62236-2429
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Country | US
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Telephone | 618-281-1888
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Fax | 618-281-1889
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Provider Business Mailing Address
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Address Line | 728 S MAIN ST
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City | COLUMBIA
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State | IL
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Zip | 62236-2429
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Country | US
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Telephone | 618-281-1888
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Fax | 618-281-1889
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Authorized Official
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Title or Position | DMD
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Name | DR. CHRISTOPHER SCOTT PUGEDA
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Credential |
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Telephone | 618-281-1888
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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 | 019025365
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License Number State | IL
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