Provider Demographics
NPI:1144364654
Name:MACE, BRANDI L (DDS)
Entity type:Individual
Prefix:DR
First Name:BRANDI
Middle Name:L
Last Name:MACE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 N 2ND AVE E
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:IA
Mailing Address - Zip Code:50208-3237
Mailing Address - Country:US
Mailing Address - Phone:641-792-9600
Mailing Address - Fax:641-792-8730
Practice Address - Street 1:108 N 2ND AVE E
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:IA
Practice Address - Zip Code:50208-3237
Practice Address - Country:US
Practice Address - Phone:641-792-9600
Practice Address - Fax:641-792-8730
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA083191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0495861Medicaid