| NPI | 1033207865 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PATTI WHITEHEAD Dental Assistant 641-684-6889 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IA 07523) |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2020-08-22 |