Provider Demographics
NPI:1700364874
Name:SPRINGBROOK FAMILY DENTISTRY, PC
Entity Type:Organization
Organization Name:SPRINGBROOK FAMILY DENTISTRY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:AARON
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:515-971-6324
Mailing Address - Street 1:214 STATE ST
Mailing Address - Street 2:
Mailing Address - City:GUTHRIE CENTER
Mailing Address - State:IA
Mailing Address - Zip Code:50115-1350
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:214 STATE ST
Practice Address - Street 2:
Practice Address - City:GUTHRIE CENTER
Practice Address - State:IA
Practice Address - Zip Code:50115-1350
Practice Address - Country:US
Practice Address - Phone:641-332-3100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-01
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IADDS-09588261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental