| NPI | 1174063010 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEVIN PAUL BAKER Owner Dentist 515-556-4530 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IA 08656) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2017-02-25 |
| Last Update Date | 2021-02-03 |