Provider Demographics
NPI:1740756139
Name:DAGUE DENTAL SOLUTIONS
Entity Type:Organization
Organization Name:DAGUE DENTAL SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOLENE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:DAGUE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:563-357-4917
Mailing Address - Street 1:6446 CAVES RD
Mailing Address - Street 2:
Mailing Address - City:MAQUOKETA
Mailing Address - State:IA
Mailing Address - Zip Code:52060-9795
Mailing Address - Country:US
Mailing Address - Phone:563-357-4917
Mailing Address - Fax:
Practice Address - Street 1:4711 N BRADY ST STE 5S
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52806-3955
Practice Address - Country:US
Practice Address - Phone:563-386-9770
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-23
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1083878896Medicaid