Provider Demographics
NPI:1174797310
Name:WESTOWN PARKWAY DENTAL AFFILIATES, PC
Entity type:Organization
Organization Name:WESTOWN PARKWAY DENTAL AFFILIATES, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:FORREST
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:515-987-7670
Mailing Address - Street 1:2375 BERKSHIRE PKWY
Mailing Address - Street 2:
Mailing Address - City:CLIVE
Mailing Address - State:IA
Mailing Address - Zip Code:50325-4677
Mailing Address - Country:US
Mailing Address - Phone:515-987-7670
Mailing Address - Fax:515-987-7671
Practice Address - Street 1:2375 BERKSHIRE PKWY
Practice Address - Street 2:
Practice Address - City:CLIVE
Practice Address - State:IA
Practice Address - Zip Code:50325-4677
Practice Address - Country:US
Practice Address - Phone:515-987-7670
Practice Address - Fax:515-987-7671
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-18
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA7057122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty