Provider Demographics
NPI:1558908145
Name:C & O DENTAL ENTERPRISES PLC
Entity Type:Organization
Organization Name:C & O DENTAL ENTERPRISES PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:CLAY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:515-570-5695
Mailing Address - Street 1:1905 N 15TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT DODGE
Mailing Address - State:IA
Mailing Address - Zip Code:50501-7604
Mailing Address - Country:US
Mailing Address - Phone:515-573-7601
Mailing Address - Fax:515-576-3962
Practice Address - Street 1:410 N WESTERN ST
Practice Address - Street 2:
Practice Address - City:SANBORN
Practice Address - State:IA
Practice Address - Zip Code:51248-1109
Practice Address - Country:US
Practice Address - Phone:712-930-5550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:C & O DENTAL ENTERPRISES, PLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-12-03
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA193400000Medicaid
IA193400000XMedicaid