Provider Demographics
NPI:1477786903
Name:CENTRAL IOWA DENTAL ARTS, LLC
Entity Type:Organization
Organization Name:CENTRAL IOWA DENTAL ARTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:ALYSE
Authorized Official - Middle Name:
Authorized Official - Last Name:WENGER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:515-964-5700
Mailing Address - Street 1:1210 NW 18TH ST
Mailing Address - Street 2:SUITE 140
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50023
Mailing Address - Country:US
Mailing Address - Phone:515-964-5700
Mailing Address - Fax:515-965-7922
Practice Address - Street 1:1210 NW 18TH ST
Practice Address - Street 2:SUITE 140
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50023
Practice Address - Country:US
Practice Address - Phone:515-964-5700
Practice Address - Fax:515-965-7922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-01
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty