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Organization
EAGLE GROVE FAMILY DENTISTRY PLC
Active
Organization
EAGLE GROVE FAMILY DENTISTRY PLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MYSTY SHAVER DDS (OWNER/DENTIST)
(515) 448-5022
Entity
Organization
Contact information
Practice address
306 W BROADWAY ST, EAGLE GROVE, IA 50533-1712
(515) 448-5022
(515) 448-5537
Mailing address
306 W BROADWAY ST, EAGLE GROVE, IA 50533-1712
(515) 448-5022
(515) 448-5537
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
09192
IA
Other
Enumeration date
09/01/2015
Last updated
09/01/2015
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