Provider Demographics
NPI:1649839887
Name:DEARDORFF, DAVID JAMES (DMD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:JAMES
Last Name:DEARDORFF
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 LOWER MUSCATINE RD
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52240-3108
Mailing Address - Country:US
Mailing Address - Phone:319-337-6226
Mailing Address - Fax:
Practice Address - Street 1:1950 LOWER MUSCATINE RD
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52240-3108
Practice Address - Country:US
Practice Address - Phone:319-337-6226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-11
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IADDS-09815122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist