| NPI | 1124307707 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JERAD LYLE HINTZ President 515-965-1653 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IA 08568) |
| Additional Taxonomies | 122300000X Dentist (Licence: IA 08845) |
| Enumeration Date | 2011-08-12 |
| Last Update Date | 2011-08-12 |