1871655159 NPI number — DUBUQUE DENTAL ASSOCIATES

Table of content: (NPI 1871655159)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871655159 NPI number — DUBUQUE DENTAL ASSOCIATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DUBUQUE DENTAL ASSOCIATES
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:
1871655159
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/14/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1890 JOHN F KENNEDY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DUBUQUE
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
52002
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
563-556-4234
Provider Business Mailing Address Fax Number:
563-556-0597

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1890 JOHN F KENNEDY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DUBUQUE
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
563-556-4234
Provider Business Practice Location Address Fax Number:
563-556-0597
Provider Enumeration Date:
12/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KILBURG
Authorized Official First Name:
BRETT
Authorized Official Middle Name:
N
Authorized Official Title or Position:
DENTIST
Authorized Official Telephone Number:
563-556-4234

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  08217 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1223G0001X , with the licence number: 05476 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223G0001X , with the licence number: 08420 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 05855 . This is a "DR JOHN MULLEN LICENSE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 485525932 . This is a "DR JOHN MULLEN SS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0081927 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0499004 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1295196 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1611620 . This is a "DR BRETT KILBURG UNITED C" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1895652 . This is a "DR MELANIE STUNT UNITED C" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0015818 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 05476 . This is a "DR HEYO TJARKS LICENSE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 08217 . This is a "DR BRETT KILBURG LICENSE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 08420 . This is a "DR MELANIE STUNT LICENSE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 478500357 . This is a "DR HEYO TJARKS SS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0762348 . This is a "DR JOHN MULLEN UNITED CON" identifier . This identifiers is of the category "OTHER".
  • Identifier: 480084209 . This is a "DR MELANIE STUNT SS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 479026247 . This is a "DR BRETT KILBURG SS" identifier . This identifiers is of the category "OTHER".




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