Provider Demographics
NPI:1841627536
Name:LIFEPOINT DENTAL PARTNERS IV
Entity type:Organization
Organization Name:LIFEPOINT DENTAL PARTNERS IV
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:LEANN
Authorized Official - Middle Name:
Authorized Official - Last Name:SOU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-224-1618
Mailing Address - Street 1:1903 EP TRUE PKWY
Mailing Address - Street 2:SUITE 301
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50265-7000
Mailing Address - Country:US
Mailing Address - Phone:515-224-1618
Mailing Address - Fax:888-278-0530
Practice Address - Street 1:137 LYNN AVE
Practice Address - Street 2:
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50014-7126
Practice Address - Country:US
Practice Address - Phone:515-292-7262
Practice Address - Fax:515-272-7270
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIFEPOINT DENTAL PARTNERS 1
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-09-26
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty