Provider Demographics
NPI:1639811169
Name:PRICE, ANNA NICOLE (DDS)
Entity type:Individual
Prefix:DR
First Name:ANNA
Middle Name:NICOLE
Last Name:PRICE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:NICOLE
Other - Last Name:FAULKNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:501 12TH AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:CORALVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52241-1774
Mailing Address - Country:US
Mailing Address - Phone:319-351-5439
Mailing Address - Fax:
Practice Address - Street 1:501 12TH AVE STE 202
Practice Address - Street 2:
Practice Address - City:CORALVILLE
Practice Address - State:IA
Practice Address - Zip Code:52241-1774
Practice Address - Country:US
Practice Address - Phone:319-351-5439
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-13
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IADDS-099911223P0221X, 390200000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes1223P0221XDental ProvidersDentistPediatric Dentistry