Provider Demographics
NPI:1922880525
Name:IOWA DENTAL HEALTH PROFESSIONALS, P.C.
Entity Type:Organization
Organization Name:IOWA DENTAL HEALTH PROFESSIONALS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:BELINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:HUERTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-540-2100
Mailing Address - Street 1:450 CROELL AVE PO BOX 322
Mailing Address - Street 2:
Mailing Address - City:TIFFIN
Mailing Address - State:IA
Mailing Address - Zip Code:52340-0322
Mailing Address - Country:US
Mailing Address - Phone:319-645-8130
Mailing Address - Fax:319-645-8132
Practice Address - Street 1:450 CROELL AVE
Practice Address - Street 2:
Practice Address - City:TIFFIN
Practice Address - State:IA
Practice Address - Zip Code:52340-4778
Practice Address - Country:US
Practice Address - Phone:319-645-8130
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:IOWA DENTAL HEALTH PROFESSIONALS, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-10-18
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty