| NPI | 1225151681 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIMBERLY JON WASS President 515-232-2152 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: IA 7768) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: IA 06812) |
| Enumeration Date | 2007-04-09 |
| Last Update Date | 2020-08-22 |