Provider Demographics
NPI: | 1497510838 |
---|---|
Name: | IOWA PEDIATRIC DENTAL SURGERY, P.L.L.C. |
Entity Type: | Organization |
Organization Name: | IOWA PEDIATRIC DENTAL SURGERY, P.L.L.C. |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | DENTIST/OWNER |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | HANS |
Authorized Official - Middle Name: | MICHAEL |
Authorized Official - Last Name: | LEONARD |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | DDS |
Authorized Official - Phone: | 319-480-4612 |
Mailing Address - Street 1: | 1111 JORDAN CREEK PKWY |
Mailing Address - Street 2: | |
Mailing Address - City: | WEST DES MOINES |
Mailing Address - State: | IA |
Mailing Address - Zip Code: | 50266-5816 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 515-222-1803 |
Mailing Address - Fax: | 515-222-1805 |
Practice Address - Street 1: | 1111 JORDAN CREEK PKWY |
Practice Address - Street 2: | |
Practice Address - City: | WEST DES MOINES |
Practice Address - State: | IA |
Practice Address - Zip Code: | 50266-5816 |
Practice Address - Country: | US |
Practice Address - Phone: | 515-222-1803 |
Practice Address - Fax: | 515-222-1805 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2024-02-15 |
Last Update Date: | 2024-02-15 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 1223P0221X | Dental Providers | Dentist | Pediatric Dentistry | Group - Single Specialty |