Provider Demographics
NPI:1609095421
Name:CEDAR RAPIDS FAMILY DENTAL CENTER PC
Entity Type:Organization
Organization Name:CEDAR RAPIDS FAMILY DENTAL CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:EVERETT
Authorized Official - Last Name:MAAS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:319-364-3221
Mailing Address - Street 1:3031 CENTER POINT RD NE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-4037
Mailing Address - Country:US
Mailing Address - Phone:319-364-3221
Mailing Address - Fax:319-364-1860
Practice Address - Street 1:3031 CENTER POINT RD NE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-4037
Practice Address - Country:US
Practice Address - Phone:319-364-3221
Practice Address - Fax:319-364-1860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA67761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty