| NPI | 1093877979 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RUSSELL E CARLSON Partner 515-279-0856 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IA 5808) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IN 6535) |
| Enumeration Date | 2006-12-15 |
| Last Update Date | 2008-04-23 |