MEDICARE: FAMILY FIRST DENTAL ASSOCIATES OF PRIMGHAR, P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1689802241
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY FIRST DENTAL ASSOCIATES OF PRIMGHAR, P.C.

Provider Business Mailing Address
First Line	:	2410 PIERCE ST
Second Line	:
City	:	SIOUX CITY
State	:	IA
Zip	:	51104-3724
Country	:	US
Telephone Number	:	712-255-5754
Fax Number	:

Provider Business Practice Location Address
First Line	:	2410 PIERCE ST
Second Line	:
City	:	SIOUX CITY
State	:	IA
Zip	:	51104-3724
Country	:	US
Telephone Number	:	712-255-5754
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. CHARLES S. SKOGLUND
Credential	:	DDS
Telephone Number	:	402-644-3177

Provider Enumeration Date	:	06/22/2009
Last Update Date	:	06/22/2009

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