Provider Demographics
NPI:1033134358
Name:JUHLIN, TODD M (DDS)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:M
Last Name:JUHLIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2814 NORTHGATE DRIVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52245
Mailing Address - Country:US
Mailing Address - Phone:641-424-1656
Mailing Address - Fax:641-424-2219
Practice Address - Street 1:2814 NORTHGATE DRIVE
Practice Address - Street 2:SUITE 2
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52245
Practice Address - Country:US
Practice Address - Phone:641-424-1656
Practice Address - Fax:641-424-2219
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA077121223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0184226Medicaid
IA0184226Medicaid
IAU75041Medicare UPIN