1598812893 NPI number — IOWA ENDODONTICS PC

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 1598812893 NPI number — IOWA ENDODONTICS PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
IOWA ENDODONTICS PC
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:
1598812893
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2525 N ANKENY BLVD
Provider Second Line Business Mailing Address:
SUITE 105
Provider Business Mailing Address City Name:
ANKENY
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50023-4703
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
515-965-4456
Provider Business Mailing Address Fax Number:
515-965-8003

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2525 N ANKENY BLVD
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
ANKENY
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50023-4703
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
515-965-4456
Provider Business Practice Location Address Fax Number:
515-965-8003
Provider Enumeration Date:
01/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SCHAEFFER
Authorized Official First Name:
MICHELLE
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT ENDODONTIST
Authorized Official Telephone Number:
515-965-4456

Provider Taxonomy Codes

  • Taxonomy code: 1223E0200X , with the licence number:  07593 , 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)





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