Provider Demographics
NPI:1275708117
Name:TIMOTHY J KREIFELS DDS PC
Entity Type:Organization
Organization Name:TIMOTHY J KREIFELS DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:J
Authorized Official - Last Name:KREIFELS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:712-243-3275
Mailing Address - Street 1:402 POPLAR ST
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC
Mailing Address - State:IA
Mailing Address - Zip Code:50022-1250
Mailing Address - Country:US
Mailing Address - Phone:712-243-3275
Mailing Address - Fax:712-243-8024
Practice Address - Street 1:402 POPLAR ST
Practice Address - Street 2:
Practice Address - City:ATLANTIC
Practice Address - State:IA
Practice Address - Zip Code:50022-1250
Practice Address - Country:US
Practice Address - Phone:712-243-3275
Practice Address - Fax:712-243-8024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA6755261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0190496Medicaid