| NPI | 1578769295 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KYLE D GAGLIARDO Co Owner 563-449-9055 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IA 06227) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IA 07929) |
| Enumeration Date | 2007-06-21 |
| Last Update Date | 2020-08-22 |