Provider Demographics
NPI:1285653345
Name:HOUK, DIANE LYNNE (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:DIANE
Middle Name:LYNNE
Last Name:HOUK
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 E 1ST ST
Mailing Address - Street 2:SUITE E250
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50021-2077
Mailing Address - Country:US
Mailing Address - Phone:515-963-9600
Mailing Address - Fax:515-963-0162
Practice Address - Street 1:800 E 1ST ST
Practice Address - Street 2:SUITE E250
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50021-2077
Practice Address - Country:US
Practice Address - Phone:515-963-9600
Practice Address - Fax:515-963-0162
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA079781223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID0460279Medicaid