Provider Demographics
NPI:1265776595
Name:MYOTECH IOWA PC
Entity type:Organization
Organization Name:MYOTECH IOWA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANCIS
Authorized Official - Middle Name:ROGER
Authorized Official - Last Name:MURRAY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:563-582-0117
Mailing Address - Street 1:666 LORAS BLVD
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52001-6233
Mailing Address - Country:US
Mailing Address - Phone:563-582-0117
Mailing Address - Fax:563-556-5065
Practice Address - Street 1:666 LORAS BLVD
Practice Address - Street 2:
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52001-6233
Practice Address - Country:US
Practice Address - Phone:563-582-0117
Practice Address - Fax:563-556-5065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-27
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty