Provider Demographics
NPI:1912014572
Name:HOUSE, ERNEST WILLIAM JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:ERNEST
Middle Name:WILLIAM
Last Name:HOUSE
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 CLEVELAND STREET
Mailing Address - Street 2:SUITE F
Mailing Address - City:MUSCATINE
Mailing Address - State:IA
Mailing Address - Zip Code:52761-5652
Mailing Address - Country:US
Mailing Address - Phone:563-263-8821
Mailing Address - Fax:563-263-8829
Practice Address - Street 1:200 CLEVELAND STREET
Practice Address - Street 2:SUITE F
Practice Address - City:MUSCATINE
Practice Address - State:IA
Practice Address - Zip Code:52761-5652
Practice Address - Country:US
Practice Address - Phone:563-263-8821
Practice Address - Fax:563-263-8829
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA55761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0113555Medicaid