| NPI | 1043871411 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSEPH BALLATORE President 319-365-6150 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2019-06-26 |
| Last Update Date | 2020-02-15 |