Organization
SHENANDOAH FAMILY DENTISTRY, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALLEN F CARRELL DDS (PRESIDENT)
(712) 246-4391
Entity
Organization
Contact information
Practice address
118 N BLOSSOM ST, SHENANDOAH, IA 51601-1206
(712) 246-4391
(712) 246-2921
Mailing address
118 N BLOSSOM ST, SHENANDOAH, IA 51601-1206
(712) 246-4391
(712) 246-2921
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
7243
IA
1223G0001X
General Practice Dentistry
7818
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0078758
—
IA
01
—
06049
BC/BS
IA
01
—
837702
UNITED CONCORDIA
—
Enumeration date
10/04/2006
Last updated
08/22/2020
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