Provider Demographics
NPI:1659442481
Name:JOEL P SARDZISNKI, DDS & ASSOCIATES, PC
Entity Type:Organization
Organization Name:JOEL P SARDZISNKI, DDS & ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:P
Authorized Official - Last Name:SARDZINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:319-396-3596
Mailing Address - Street 1:1700 BLAIRS FERRY RD
Mailing Address - Street 2:
Mailing Address - City:HIAWATHA
Mailing Address - State:IA
Mailing Address - Zip Code:52233-2033
Mailing Address - Country:US
Mailing Address - Phone:319-396-3596
Mailing Address - Fax:319-378-0546
Practice Address - Street 1:1700 BLAIRS FERRY RD
Practice Address - Street 2:
Practice Address - City:HIAWATHA
Practice Address - State:IA
Practice Address - Zip Code:52233-2033
Practice Address - Country:US
Practice Address - Phone:319-396-3596
Practice Address - Fax:319-378-0546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA077431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1133264Medicaid