Provider Demographics
NPI:1730309949
Name:DUTKOWSKI LUDENS, RENE ANN (DDS)
Entity Type:Individual
Prefix:DR
First Name:RENE
Middle Name:ANN
Last Name:DUTKOWSKI LUDENS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 OLYMPIC DR.
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50701-5240
Mailing Address - Country:US
Mailing Address - Phone:319-234-3233
Mailing Address - Fax:319-234-3879
Practice Address - Street 1:208 OLYMPIC DR.
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50701-5240
Practice Address - Country:US
Practice Address - Phone:319-234-3233
Practice Address - Fax:319-234-3879
Is Sole Proprietor?:No
Enumeration Date:2007-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA7780122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1124768Medicare ID - Type Unspecified