1447249230 NPI number — ASSOCIATE DENTISTS, P.C.

Table of content: (NPI 1447249230)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447249230 NPI number — ASSOCIATE DENTISTS, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ASSOCIATE DENTISTS, 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:
1447249230
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3549 11TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COUNCIL BLUFFS
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
51501-5641
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
712-328-0708
Provider Business Mailing Address Fax Number:
712-328-8991

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3549 11TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COUNCIL BLUFFS
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
51501-5641
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
712-328-0708
Provider Business Practice Location Address Fax Number:
712-328-8991
Provider Enumeration Date:
10/14/2005

Additional Information

Authorized Official

Authorized Official Last Name:
PINKHAM
Authorized Official First Name:
JIMMIE
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
OWNER/DENTIST
Authorized Official Telephone Number:
712-328-0708

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  7623 , 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: 0094250 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com