Provider Demographics
NPI:1215034889
Name:ORAL SURGERY ASSOC OF IOWA CITY PC
Entity Type:Organization
Organization Name:ORAL SURGERY ASSOC OF IOWA CITY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:HARTWIG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS PHD
Authorized Official - Phone:319-338-5484
Mailing Address - Street 1:2814 NORTHGATE DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52245-9568
Mailing Address - Country:US
Mailing Address - Phone:319-338-5484
Mailing Address - Fax:319-338-9413
Practice Address - Street 1:2814 NORTHGATE DR
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:319-338-5484
Practice Address - Fax:319-338-9413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-17
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI15366Medicare ID - Type UnspecifiedMEDICARE NUMBER