| NPI | 1891083002 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TANNER CLARK President 319-626-3161 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: IA 08218) |
| Enumeration Date | 2011-07-21 |
| Last Update Date | 2012-01-27 |