Provider Demographics
NPI:1629280193
Name:ENDODONTIC ASSOCIATES OF IOWA CITY PC
Entity Type:Organization
Organization Name:ENDODONTIC ASSOCIATES OF IOWA CITY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:CHRISTIAN
Authorized Official - Last Name:HANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:319-351-6622
Mailing Address - Street 1:2814 NORTHGATE DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52245-9513
Mailing Address - Country:US
Mailing Address - Phone:319-351-6622
Mailing Address - Fax:319-351-2696
Practice Address - Street 1:2814 NORTHGATE DR
Practice Address - Street 2:SUITE 1
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52245-9513
Practice Address - Country:US
Practice Address - Phone:319-351-6622
Practice Address - Fax:319-351-2696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA71621223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty