Provider Demographics
NPI:1740649912
Name:DESIGN DENTAL, INC.
Entity type:Organization
Organization Name:DESIGN DENTAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHIN-ING
Authorized Official - Middle Name:JEREMY
Authorized Official - Last Name:TU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:319-626-2222
Mailing Address - Street 1:115 N. HWY 965
Mailing Address - Street 2:PO BOX 915
Mailing Address - City:NORTH LIBERTY
Mailing Address - State:IA
Mailing Address - Zip Code:52317
Mailing Address - Country:US
Mailing Address - Phone:319-626-2222
Mailing Address - Fax:319-626-6610
Practice Address - Street 1:115 N. HWY 965
Practice Address - Street 2:
Practice Address - City:NORTH LIBERTY
Practice Address - State:IA
Practice Address - Zip Code:52317
Practice Address - Country:US
Practice Address - Phone:319-626-2222
Practice Address - Fax:319-626-6610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-17
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA207719261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0279349Medicaid
IA1790871531OtherNPI