Provider Demographics
NPI:1700881570
Name:BUEHLER, JODIE ALAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:JODIE
Middle Name:ALAN
Last Name:BUEHLER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 NORTH MAIN STREET
Mailing Address - Street 2:SUITE 3
Mailing Address - City:CHARLES CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50616-2125
Mailing Address - Country:US
Mailing Address - Phone:641-228-2936
Mailing Address - Fax:641-257-6456
Practice Address - Street 1:705 NORTH MAIN STREET
Practice Address - Street 2:SUITE 3
Practice Address - City:CHARLES CITY
Practice Address - State:IA
Practice Address - Zip Code:50616-2125
Practice Address - Country:US
Practice Address - Phone:641-228-2936
Practice Address - Fax:641-257-6456
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2007-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA074361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0295493Medicaid