Provider Demographics
NPI:1346624020
Name:SASS MEINCKE, LAURA FITZPATRICK (DDS)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:FITZPATRICK
Last Name:SASS MEINCKE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:LAURA
Other - Middle Name:FITZPATRICK
Other - Last Name:SASS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 399
Mailing Address - Street 2:
Mailing Address - City:WILTON
Mailing Address - State:IA
Mailing Address - Zip Code:52778-0399
Mailing Address - Country:US
Mailing Address - Phone:563-732-2612
Mailing Address - Fax:
Practice Address - Street 1:325 CEDAR ST
Practice Address - Street 2:
Practice Address - City:WILTON
Practice Address - State:IA
Practice Address - Zip Code:52778-7713
Practice Address - Country:US
Practice Address - Phone:563-732-2612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-13
Last Update Date:2019-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IADDS-092191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAPENDINGMedicaid