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>> Dentist >> Dental Providers

Registrant NPI Number: 1245364033

Individual Registrant:
Gender: M
Not Sole Proprietor

Location and contact information for practice:
Tel: 319-372-8540  Fax: 319-372-1127

Contact information for business:
Tel: 319-372-8540  Fax: 319-372-1127

Registration Information:
NPI: 1245364033
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y122300000XDental Providers

Legacy codes, insurance codes and state license numbers:



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