Provider Demographics
NPI:1881129906
Name:INDIAN HILLS COMMUNITY COLLEGE DENTAL HYGIENE CLINIC
Entity type:Organization
Organization Name:INDIAN HILLS COMMUNITY COLLEGE DENTAL HYGIENE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTAL HYGIENE PROGRAM DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JODY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:RDH, MA
Authorized Official - Phone:641-683-5120
Mailing Address - Street 1:525 GRANDVIEW AVENUE
Mailing Address - Street 2:
Mailing Address - City:OTTUMWA
Mailing Address - State:IA
Mailing Address - Zip Code:52501
Mailing Address - Country:US
Mailing Address - Phone:641-683-5120
Mailing Address - Fax:
Practice Address - Street 1:525 GRANDVIEW AVE
Practice Address - Street 2:
Practice Address - City:OTTUMWA
Practice Address - State:IA
Practice Address - Zip Code:52501-1359
Practice Address - Country:US
Practice Address - Phone:641-683-5120
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-26
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental