# EAGLE GROVE FAMILY DENTISTRY PLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1831566330
- **Authorized official:** DR. MYSTY SHAVER DDS (OWNER/DENTIST)
- **Authorized official phone:** (515) 448-5022

## Contact information

- **Practice address:** 306 W BROADWAY ST, EAGLE GROVE, IA 50533-1712
- **Practice address phone:** (515) 448-5022
- **Practice address fax:** (515) 448-5537
- **Mailing address:** 306 W BROADWAY ST, EAGLE GROVE, IA 50533-1712
- **Mailing address phone:** (515) 448-5022
- **Mailing address fax:** (515) 448-5537

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 09192 | IA | Yes |

## Other

- **Enumeration date:** 09/01/2015
- **Last updated:** 09/01/2015