Provider Demographics
NPI:1932571965
Name:IOWA DERMATOLOGY CLINIC, PLC
Entity Type:Organization
Organization Name:IOWA DERMATOLOGY CLINIC, PLC
Other - Org Name:RADIANT COMPLEXIONS DERMATOLOGY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:LOVE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:515-226-8484
Mailing Address - Street 1:26 S 1ST AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MARSHALLTOWN
Mailing Address - State:IA
Mailing Address - Zip Code:50158-5034
Mailing Address - Country:US
Mailing Address - Phone:641-753-2125
Mailing Address - Fax:641-753-2509
Practice Address - Street 1:26 S 1ST AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:MARSHALLTOWN
Practice Address - State:IA
Practice Address - Zip Code:50158-5034
Practice Address - Country:US
Practice Address - Phone:641-753-2125
Practice Address - Fax:641-753-2509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-29
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty