| NPI | 1043755408 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SARAH E SWENSON Manager 319-364-2413 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: IA 08795) |
| Additional Taxonomies | 1223P0221X Dentist Pediatric Dentistry (Licence: IA 08765) |
| Enumeration Date | 2016-12-21 |
| Last Update Date | 2016-12-21 |