Provider Demographics
NPI:1649433871
Name:MACE FAMILY DENTAL
Entity type:Organization
Organization Name:MACE FAMILY DENTAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRANDI
Authorized Official - Middle Name:L
Authorized Official - Last Name:MACE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:641-792-9600
Mailing Address - Street 1:108 N 2ND AVE E
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:IA
Mailing Address - Zip Code:50208-3237
Mailing Address - Country:US
Mailing Address - Phone:641-792-9600
Mailing Address - Fax:641-792-8730
Practice Address - Street 1:108 N 2ND AVE E
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:IA
Practice Address - Zip Code:50208-3237
Practice Address - Country:US
Practice Address - Phone:641-792-9600
Practice Address - Fax:641-792-8730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-08
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty