Provider Demographics
NPI:1578945614
Name:IOWA DENTAL HEALTH PROFESSIONALS, P.C.
Entity Type:Organization
Organization Name:IOWA DENTAL HEALTH PROFESSIONALS, P.C.
Other - Org Name:SEASONS FAMILY DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INSURANCE
Authorized Official - Prefix:
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:
Authorized Official - Last Name:WOODS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-774-2052
Mailing Address - Street 1:2215 EDGEWOOD RD SW STE 1
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52404-4734
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2215 EDGEWOOD RD SW STE 1
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52404-4734
Practice Address - Country:US
Practice Address - Phone:319-774-2052
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:IOWA DENTAL HEALTH PROFESSIONALS, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-06-25
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty