Provider Demographics
NPI:1336308014
Name:INDIANOLA DENTAL ASSOCIATES INC PC
Entity Type:Organization
Organization Name:INDIANOLA DENTAL ASSOCIATES INC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:ZABORAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-961-0534
Mailing Address - Street 1:212 NORTH BUXTON
Mailing Address - Street 2:
Mailing Address - City:INDIANOLA
Mailing Address - State:IA
Mailing Address - Zip Code:50125-2431
Mailing Address - Country:US
Mailing Address - Phone:515-961-0534
Mailing Address - Fax:
Practice Address - Street 1:212 NORTH BUXTON
Practice Address - Street 2:
Practice Address - City:INDIANOLA
Practice Address - State:IA
Practice Address - Zip Code:50125-2431
Practice Address - Country:US
Practice Address - Phone:515-961-0534
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-06
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA069221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty