Provider Demographics
NPI:1801316641
Name:PARKWAY DENTAL - HELPER LLC
Entity type:Organization
Organization Name:PARKWAY DENTAL - HELPER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-201-6940
Mailing Address - Street 1:48 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HELPER
Mailing Address - State:UT
Mailing Address - Zip Code:84526-1560
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:48 S MAIN ST
Practice Address - Street 2:
Practice Address - City:HELPER
Practice Address - State:UT
Practice Address - Zip Code:84526-1560
Practice Address - Country:US
Practice Address - Phone:435-201-6940
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-22
Last Update Date:2017-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5500786-9922261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1508191883Medicaid