Provider Demographics
NPI:1609060433
Name:ADVANCED DENTAL CARE, PC
Entity Type:Organization
Organization Name:ADVANCED DENTAL CARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:SCHULLER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:319-378-4100
Mailing Address - Street 1:2335 BLAIRS FERRY RD NE
Mailing Address - Street 2:SUITE B
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-1918
Mailing Address - Country:US
Mailing Address - Phone:319-378-4100
Mailing Address - Fax:319-378-4108
Practice Address - Street 1:2335 BLAIRS FERRY RD NE
Practice Address - Street 2:SUITE B
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-1918
Practice Address - Country:US
Practice Address - Phone:319-378-4100
Practice Address - Fax:319-378-4108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-05
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06013261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental