Provider Demographics
NPI:1417015595
Name:STREAM, RODNEY R (DDS)
Entity Type:Individual
Prefix:
First Name:RODNEY
Middle Name:R
Last Name:STREAM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:934 N 7TH STREET
Mailing Address - Street 2:
Mailing Address - City:CHARITON
Mailing Address - State:IA
Mailing Address - Zip Code:50049
Mailing Address - Country:US
Mailing Address - Phone:641-774-5031
Mailing Address - Fax:641-774-4454
Practice Address - Street 1:934 N 7TH STREET
Practice Address - Street 2:
Practice Address - City:CHARITON
Practice Address - State:IA
Practice Address - Zip Code:50049
Practice Address - Country:US
Practice Address - Phone:641-774-5031
Practice Address - Fax:641-774-4454
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA6159122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0143461Medicaid