Provider Demographics
NPI:1336634799
Name:NISHNA VALLEY DENTAL
Entity Type:Organization
Organization Name:NISHNA VALLEY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TAYLOR
Authorized Official - Middle Name:J
Authorized Official - Last Name:SCHROEDER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:712-243-6545
Mailing Address - Street 1:211 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC
Mailing Address - State:IA
Mailing Address - Zip Code:50022-1062
Mailing Address - Country:US
Mailing Address - Phone:712-243-6545
Mailing Address - Fax:712-243-9739
Practice Address - Street 1:211 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:ATLANTIC
Practice Address - State:IA
Practice Address - Zip Code:50022-1062
Practice Address - Country:US
Practice Address - Phone:712-243-6545
Practice Address - Fax:712-243-9739
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-28
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA08886261QD0000X
IA09290261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental