Organization
HILL AVENUE DENTAL LLC
Active
Parent organization
VIDENTA, LLC
Other names
Hill Avenue Dental
Organization subpart
Yes
Provider details
NPI number
Legal business name
VIDENTA, LLC
Authorized official
LUCAS BLAND (COO)
(515) 577-6367
Entity
Organization
Contact information
Practice address
1510 HILL AVE STE D, SPIRIT LAKE, IA 51360-1676
(712) 336-4895
Mailing address
907 N ANKENY BLVD, ANKENY, IA 50023-4002
(515) 577-6367
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
03/22/2024
Last updated
03/22/2024
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