| NPI | 1205975505 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEAN M HOOVER Office Manager 515-576-8151 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: IA 6251) |
| Enumeration Date | 2007-02-05 |
| Last Update Date | 2020-08-22 |