| NPI | 1962661256 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICO L BERTAGNOLLI Dentist 515-262-9581 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IA 7377) |
| Enumeration Date | 2008-06-03 |
| Last Update Date | 2008-06-03 |