| NPI | 1558403188 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIM J. WASS President 515-232-2152 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: IA 6812) |
| Enumeration Date | 2007-02-12 |
| Last Update Date | 2020-08-22 |