Provider Demographics
NPI:1609984434
Name:PARKVIEW FAMILY DENTISTRY PC
Entity type:Organization
Organization Name:PARKVIEW FAMILY DENTISTRY PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:ALBERT
Authorized Official - Last Name:RUSCH
Authorized Official - Suffix:III
Authorized Official - Credentials:DDS
Authorized Official - Phone:765-529-7616
Mailing Address - Street 1:340 PARKVIEW DR
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:IN
Mailing Address - Zip Code:47362-2945
Mailing Address - Country:US
Mailing Address - Phone:765-529-7616
Mailing Address - Fax:765-529-5676
Practice Address - Street 1:340 PARKVIEW DR
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:IN
Practice Address - Zip Code:47362-2945
Practice Address - Country:US
Practice Address - Phone:765-529-7616
Practice Address - Fax:765-529-5676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010274122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty