Provider Demographics
NPI:1497825954
Name:MELROSE DENTAL OFFICE P.L.C.
Entity Type:Organization
Organization Name:MELROSE DENTAL OFFICE P.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:HEDLUND
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:319-338-6896
Mailing Address - Street 1:1000 MELROSE AVE
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52246-1924
Mailing Address - Country:US
Mailing Address - Phone:319-338-6896
Mailing Address - Fax:319-338-9985
Practice Address - Street 1:1000 MELROSE AVE
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52246-1924
Practice Address - Country:US
Practice Address - Phone:319-338-6896
Practice Address - Fax:319-338-9985
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2009-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty