Provider Demographics
NPI:1942735519
Name:EASTERN IOWA ENDODONTICS, PC
Entity Type:Organization
Organization Name:EASTERN IOWA ENDODONTICS, PC
Other - Org Name:EASTERN IOWA ENDODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:PEEK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:319-382-8002
Mailing Address - Street 1:2929 CENTER POINT RD NE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-4035
Mailing Address - Country:US
Mailing Address - Phone:319-382-8002
Mailing Address - Fax:319-382-8111
Practice Address - Street 1:2929 CENTER POINT RD NE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-4035
Practice Address - Country:US
Practice Address - Phone:319-382-8002
Practice Address - Fax:319-382-8111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-20
Last Update Date:2019-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA91611223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty