Provider Demographics
NPI:1467635961
Name:DAHM, JEFFREY P
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:P
Last Name:DAHM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 TERRACE DR
Mailing Address - Street 2:
Mailing Address - City:OTLEY
Mailing Address - State:IA
Mailing Address - Zip Code:50214-8514
Mailing Address - Country:US
Mailing Address - Phone:641-627-5210
Mailing Address - Fax:
Practice Address - Street 1:2018 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:PELLA
Practice Address - State:IA
Practice Address - Zip Code:50219-7881
Practice Address - Country:US
Practice Address - Phone:641-628-2468
Practice Address - Fax:641-628-8247
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-07
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAIA75301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA46177OtherWELLMARK
IA1086249Medicaid