Provider Demographics
NPI:1164817888
Name:EPWORTH FAMILY DENTISTRY, P.C.
Entity Type:Organization
Organization Name:EPWORTH FAMILY DENTISTRY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KIM
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:KISSELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-876-3396
Mailing Address - Street 1:255 BIERMAN RD
Mailing Address - Street 2:P.O. BOX 285
Mailing Address - City:EPWORTH
Mailing Address - State:IA
Mailing Address - Zip Code:52045-9529
Mailing Address - Country:US
Mailing Address - Phone:563-876-3396
Mailing Address - Fax:563-876-3645
Practice Address - Street 1:255 BIERMAN RD
Practice Address - Street 2:
Practice Address - City:EPWORTH
Practice Address - State:IA
Practice Address - Zip Code:52045-9529
Practice Address - Country:US
Practice Address - Phone:563-876-3396
Practice Address - Fax:563-876-3645
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-31
Last Update Date:2015-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty