Provider Demographics
NPI:1013215243
Name:LIFEPOINT II DENTAL GROUP
Entity Type:Organization
Organization Name:LIFEPOINT II DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGELINA
Authorized Official - Middle Name:
Authorized Official - Last Name:BLASS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:515-965-5999
Mailing Address - Street 1:2785 N ANKENY BLVD STE 26
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50023-4705
Mailing Address - Country:US
Mailing Address - Phone:515-965-5999
Mailing Address - Fax:515-965-5832
Practice Address - Street 1:2785 N ANKENY BLVD STE 26
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50023-4705
Practice Address - Country:US
Practice Address - Phone:515-965-5999
Practice Address - Fax:515-965-5832
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIFEPOINT DENTAL GROUP, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-03-12
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty