Provider Demographics
NPI:1063670149
Name:DENTAL OFFICE
Entity Type:Organization
Organization Name:DENTAL OFFICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THAD
Authorized Official - Middle Name:MARSH
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:712-668-2219
Mailing Address - Street 1:300 S MAIN
Mailing Address - Street 2:
Mailing Address - City:ODEBOLT
Mailing Address - State:IA
Mailing Address - Zip Code:51458-0660
Mailing Address - Country:US
Mailing Address - Phone:712-668-2219
Mailing Address - Fax:
Practice Address - Street 1:300 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ODEBOLT
Practice Address - State:IA
Practice Address - Zip Code:51458-7719
Practice Address - Country:US
Practice Address - Phone:712-668-2219
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-27
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06795122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty