Provider Demographics
NPI:1235483280
Name:NE IOWA DENTAL ASSOCIATES
Entity Type:Organization
Organization Name:NE IOWA DENTAL ASSOCIATES
Other - Org Name:ALAN W. KRUGER, DDS, PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:KRUGER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:319-283-4222
Mailing Address - Street 1:135 7TH ST. SE
Mailing Address - Street 2:
Mailing Address - City:OELWEIN
Mailing Address - State:IA
Mailing Address - Zip Code:50662-2811
Mailing Address - Country:US
Mailing Address - Phone:319-283-4222
Mailing Address - Fax:319-283-5686
Practice Address - Street 1:135 7TH ST. SE
Practice Address - Street 2:
Practice Address - City:OELWEIN
Practice Address - State:IA
Practice Address - Zip Code:50662-2811
Practice Address - Country:US
Practice Address - Phone:319-283-4222
Practice Address - Fax:319-283-5686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-30
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA159707Medicaid