| NPI | 1154779676 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NATHAN LEINEN Secretary/Treasurer 515-446-0733 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IA 8260) |
| Additional Taxonomies | 122300000X Dentist (Licence: IA 8918) |
| Enumeration Date | 2016-05-25 |
| Last Update Date | 2016-05-25 |