| NPI | 1588082739 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LEANN KIM SOU Office Manager 515-243-4616 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IA 08454) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IA 08950) |
| Enumeration Date | 2014-04-04 |
| Last Update Date | 2014-04-04 |