Provider Demographics
NPI:1720128465
Name:ANKENY DENTAL ASSOCIATES, PLC
Entity Type:Organization
Organization Name:ANKENY DENTAL ASSOCIATES, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:D
Authorized Official - Last Name:LUND
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:515-964-0081
Mailing Address - Street 1:401 NW 18TH ST
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50023-4260
Mailing Address - Country:US
Mailing Address - Phone:515-964-0081
Mailing Address - Fax:515-964-2902
Practice Address - Street 1:401 NW 18TH ST
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50023-4260
Practice Address - Country:US
Practice Address - Phone:515-964-0081
Practice Address - Fax:515-964-2902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA61131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty