Provider Demographics
NPI:1205910924
Name:MORELAND-BENDER DENTAL ASSOCIATES,LLP
Entity type:Organization
Organization Name:MORELAND-BENDER DENTAL ASSOCIATES,LLP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:RUTH
Authorized Official - Last Name:PUMP
Authorized Official - Suffix:
Authorized Official - Credentials:CDA,RDA
Authorized Official - Phone:319-354-1409
Mailing Address - Street 1:1513 MALL DR
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52240-3111
Mailing Address - Country:US
Mailing Address - Phone:319-354-1409
Mailing Address - Fax:319-354-3113
Practice Address - Street 1:1513 MALL DR
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52240-3111
Practice Address - Country:US
Practice Address - Phone:319-354-1409
Practice Address - Fax:319-354-3113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA05960122300000X
IA07551122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA41887OtherDELTA AND WELLMARK
IA26043OtherDELTA AND WELLMARK