| NPI | 1043479421 |
|---|---|
| Former Legal Business Name | NONE |
| Entity Type | Organization |
| Authorized Contact | JON L SUNSTROM President 515-432-4223 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: IA 6579) |
| Enumeration Date | 2008-06-02 |
| Last Update Date | 2008-06-02 |