| NPI | 1982938080 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRIS ROBERT HAGANMAN Owner 319-321-0251 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IA 6909) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IA 8146) |
| 1223G0001X Dentist, General Practice (Licence: IA 07446) | |
| Enumeration Date | 2009-09-23 |
| Last Update Date | 2017-08-23 |