Provider Demographics
NPI:1346630654
Name:IOWA DENTAL HEALTH PROFESSIONALS, P.C.
Entity Type:Organization
Organization Name:IOWA DENTAL HEALTH PROFESSIONALS, P.C.
Other - Org Name:FAMILY DENTAL CARE OF SIOUX CITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:
Authorized Official - Last Name:WOODS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-522-3274
Mailing Address - Street 1:5738 SUNNYBROOK DR
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51106-4249
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5738 SUNNYBROOK DR
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51106-4249
Practice Address - Country:US
Practice Address - Phone:217-540-5141
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:IOWA DENTAL HEALTH PROFESSIONALS, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-01-26
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty