Provider Demographics
NPI:1871682807
Name:TOWNCREST DENTAL OFFICES PC
Entity Type:Organization
Organization Name:TOWNCREST DENTAL OFFICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:R
Authorized Official - Last Name:DAVIDSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:319-337-2114
Mailing Address - Street 1:1008 WILLIAM ST
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52240-6625
Mailing Address - Country:US
Mailing Address - Phone:319-337-2114
Mailing Address - Fax:319-337-3382
Practice Address - Street 1:1008 WILLIAM ST
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52240-6625
Practice Address - Country:US
Practice Address - Phone:319-337-2114
Practice Address - Fax:319-337-3382
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2013-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA077671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty