Provider Demographics
NPI:1891826335
Name:DEBRA K. OLDHAM DDS PC
Entity Type:Organization
Organization Name:DEBRA K. OLDHAM DDS PC
Other - Org Name:ANAMOSA DENTAL ASSOC. PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:F
Authorized Official - Last Name:OLDHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-462-2531
Mailing Address - Street 1:702 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ANAMOSA
Mailing Address - State:IA
Mailing Address - Zip Code:52205-1636
Mailing Address - Country:US
Mailing Address - Phone:319-462-2531
Mailing Address - Fax:319-462-2914
Practice Address - Street 1:702 W MAIN ST
Practice Address - Street 2:
Practice Address - City:ANAMOSA
Practice Address - State:IA
Practice Address - Zip Code:52205-1636
Practice Address - Country:US
Practice Address - Phone:319-462-2531
Practice Address - Fax:319-462-2914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA42053OtherDELTA DENTAL