| NPI | 1346377918 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA M SHANNON Office Manager 319-365-0534 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: IA 7446) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: IA 7949) |
| 1223G0001X Dentist General Practice (Licence: IA 7588) | |
| 1223P0700X Dentist Prosthodontics (Licence: IA 7446) | |
| Enumeration Date | 2007-02-28 |
| Last Update Date | 2020-08-22 |