Provider Demographics
NPI:1376700898
Name:LECHTENBERG DENTAL CLINIC
Entity Type:Organization
Organization Name:LECHTENBERG DENTAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:A
Authorized Official - Last Name:LECHTENBERG
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:563-652-3438
Mailing Address - Street 1:129 W PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:MAQUOKETA
Mailing Address - State:IA
Mailing Address - Zip Code:52060-3046
Mailing Address - Country:US
Mailing Address - Phone:563-652-3438
Mailing Address - Fax:563-652-0138
Practice Address - Street 1:129 W PLEASANT ST
Practice Address - Street 2:
Practice Address - City:MAQUOKETA
Practice Address - State:IA
Practice Address - Zip Code:52060-3046
Practice Address - Country:US
Practice Address - Phone:563-652-3438
Practice Address - Fax:563-652-0138
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA7451122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0080440Medicaid
07318OtherWELLMARK
841612OtherUNITED CONCORDIA