1316483647 NPI number — BYLSMA-MULDER FAMILY DENTISTRY, P.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316483647 NPI number — BYLSMA-MULDER FAMILY DENTISTRY, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BYLSMA-MULDER FAMILY DENTISTRY, P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1316483647
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/10/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
159 S MAIN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SIOUX CENTER
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
51250-1535
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
712-722-2633
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
159 S MAIN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SIOUX CENTER
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
51250-1535
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
712-722-2633
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/10/2017

Additional Information

Authorized Official

Authorized Official Last Name:
HULSTEIN
Authorized Official First Name:
FONDA
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
712-722-2633

Provider Taxonomy Codes

  • Taxonomy code: 261QD0000X , with the licence number:  7596 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0091488 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".




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