Provider Demographics
NPI:1376913780
Name:IOWA DENTAL HEALTH PROFESSIONALS, PC
Entity Type:Organization
Organization Name:IOWA DENTAL HEALTH PROFESSIONALS, PC
Other - Org Name:SMILES ON DELAWARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:KENDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-540-8312
Mailing Address - Street 1:2005 SE DELAWARE AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50021-4302
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2005 SE DELAWARE AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50021-4302
Practice Address - Country:US
Practice Address - Phone:515-446-3896
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:IOWA DENTAL HEALTH PROFESSIONALS, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-09-28
Last Update Date:2015-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty