Provider Demographics
NPI:1740005321
Name:DW DENTAL LLC
Entity type:Organization
Organization Name:DW DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DILLON
Authorized Official - Middle Name:TYLER
Authorized Official - Last Name:WOODS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:402-669-7536
Mailing Address - Street 1:3549 11TH AVE
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51501-5641
Mailing Address - Country:US
Mailing Address - Phone:712-328-0708
Mailing Address - Fax:712-328-8991
Practice Address - Street 1:3549 11TH AVE
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51501-5641
Practice Address - Country:US
Practice Address - Phone:712-328-0708
Practice Address - Fax:712-328-8991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-19
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental