| NPI | 1689898603 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LORI WHEELER Office Manager 563-359-9165 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IA 6110) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IA 6313) |
| 1223G0001X Dentist, General Practice (Licence: IA 7473) | |
| 1223G0001X Dentist, General Practice (Licence: IA 08354) | |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: IA 7498) | |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: IA 7854) | |
| Enumeration Date | 2007-04-12 |
| Last Update Date | 2020-08-22 |