Provider Demographics
NPI:1306851159
Name:DRS LANGWITH HULL & ROUSH PC
Entity Type:Organization
Organization Name:DRS LANGWITH HULL & ROUSH PC
Other - Org Name:DRS LANGWITH HULL BERNHARDT & SMITH PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:K
Authorized Official - Last Name:HENNICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-253-0911
Mailing Address - Street 1:6105 NW 86TH STREET
Mailing Address - Street 2:
Mailing Address - City:JOHNSTON
Mailing Address - State:IA
Mailing Address - Zip Code:50131-2240
Mailing Address - Country:US
Mailing Address - Phone:515-253-0911
Mailing Address - Fax:515-331-6652
Practice Address - Street 1:6105 NW 86TH STREET
Practice Address - Street 2:
Practice Address - City:JOHNSTON
Practice Address - State:IA
Practice Address - Zip Code:50131-2240
Practice Address - Country:US
Practice Address - Phone:515-253-0911
Practice Address - Fax:515-331-6652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA063711223X0400X
IA063911223X0400X
IA075531223X0400X
IA075131223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty