| NPI | 1598133514 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VALERIE PECKOSH Owner 563-582-1478 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IA 08006) |
| Additional Taxonomies | 122300000X Dentist (Licence: IA 08808) |
| Enumeration Date | 2015-09-08 |
| Last Update Date | 2015-09-29 |