Provider Demographics
NPI:1235660259
Name:MEDI-DENT, INC
Entity Type:Organization
Organization Name:MEDI-DENT, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANCIS
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:CONNELLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-450-0281
Mailing Address - Street 1:1050 15TH ST SW
Mailing Address - Street 2:SUITE #2
Mailing Address - City:MASON CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50401-5677
Mailing Address - Country:US
Mailing Address - Phone:641-450-0281
Mailing Address - Fax:641-450-0284
Practice Address - Street 1:1050 15TH ST SW
Practice Address - Street 2:SUITE #2
Practice Address - City:MASON CITY
Practice Address - State:IA
Practice Address - Zip Code:50401-5677
Practice Address - Country:US
Practice Address - Phone:641-450-0281
Practice Address - Fax:641-450-0284
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-22
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Single Specialty