Provider Demographics
NPI:1649639295
Name:DARLING, BRIAN
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:DARLING
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 W 2ND ST STE 4
Mailing Address - Street 2:
Mailing Address - City:OTTUMWA
Mailing Address - State:IA
Mailing Address - Zip Code:52501-2506
Mailing Address - Country:US
Mailing Address - Phone:641-575-0611
Mailing Address - Fax:641-575-0622
Practice Address - Street 1:301 W 2ND ST STE 4
Practice Address - Street 2:
Practice Address - City:OTTUMWA
Practice Address - State:IA
Practice Address - Zip Code:52501-2506
Practice Address - Country:US
Practice Address - Phone:641-575-0611
Practice Address - Fax:641-575-0622
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-10
Last Update Date:2022-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20180155881223S0112X
IA099621223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO400055093Medicaid