Provider Demographics
NPI:1346407590
Name:IOWA PERIODONTICS, P.C.
Entity Type:Organization
Organization Name:IOWA PERIODONTICS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DE ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:SWENSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-223-5225
Mailing Address - Street 1:4090 WESTOWN PKWY
Mailing Address - Street 2:SUITE A-5
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-6760
Mailing Address - Country:US
Mailing Address - Phone:515-223-5225
Mailing Address - Fax:515-223-8630
Practice Address - Street 1:4090 WESTOWN PKWY
Practice Address - Street 2:SUITE A-5
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-6760
Practice Address - Country:US
Practice Address - Phone:515-223-5225
Practice Address - Fax:515-223-8630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-16
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty