Provider Demographics
NPI:1477098648
Name:AUDUBON DENTAL CENTER LLC
Entity Type:Organization
Organization Name:AUDUBON DENTAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:GERALD
Authorized Official - Last Name:FLESHNER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:712-563-2659
Mailing Address - Street 1:400 N PARK PL
Mailing Address - Street 2:
Mailing Address - City:AUDUBON
Mailing Address - State:IA
Mailing Address - Zip Code:50025-1239
Mailing Address - Country:US
Mailing Address - Phone:712-563-2659
Mailing Address - Fax:712-563-2659
Practice Address - Street 1:400 N PARK PL
Practice Address - Street 2:
Practice Address - City:AUDUBON
Practice Address - State:IA
Practice Address - Zip Code:50025-1239
Practice Address - Country:US
Practice Address - Phone:712-563-2659
Practice Address - Fax:712-563-2659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-27
Last Update Date:2016-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA08747122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty