Provider Demographics
NPI:1760530448
Name:DAHM DENTAL, P.C.
Entity Type:Organization
Organization Name:DAHM DENTAL, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:P
Authorized Official - Last Name:DAHM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:641-628-2468
Mailing Address - Street 1:2018 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:PELLA
Mailing Address - State:IA
Mailing Address - Zip Code:50219-7881
Mailing Address - Country:US
Mailing Address - Phone:641-628-8247
Mailing Address - Fax:641-628-8247
Practice Address - Street 1:2018 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:PELLA
Practice Address - State:IA
Practice Address - Zip Code:50219-7881
Practice Address - Country:US
Practice Address - Phone:641-628-2468
Practice Address - Fax:641-628-8247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAIA75301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1086249Medicaid