| NPI | 1336511120 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATHRYN A KELL President 563-355-6626 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: IA 06415) |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental (Licence: IA 8500) |
| Enumeration Date | 2015-10-20 |
| Last Update Date | 2015-10-20 |