| NPI | 1548971799 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAMMY R BOHNENKAMP Owner 712-546-5183 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| Additional Taxonomies | 1223G0001X Dentist, General Practice |
| 261QD0000X Clinic/Center, Dental | |
| Enumeration Date | 2022-12-08 |
| Last Update Date | 2026-02-12 |