MEDICARE: MORELAND-BENDER DENTAL ASSOCIATES,LLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	05960	IA
2	122300000X	Dentist	07551	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	41887	OTHER	IA	DELTA AND WELLMARK
2	26043	OTHER	IA	DELTA AND WELLMARK

General Provider Information

NPI Number	:	1205910924
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MORELAND-BENDER DENTAL ASSOCIATES,LLP

Provider Business Mailing Address
First Line	:	1513 MALL DR
Second Line	:
City	:	IOWA CITY
State	:	IA
Zip	:	52240-3111
Country	:	US
Telephone Number	:	319-354-1409
Fax Number	:	319-354-3113

Provider Business Practice Location Address
First Line	:	1513 MALL DR
Second Line	:
City	:	IOWA CITY
State	:	IA
Zip	:	52240-3111
Country	:	US
Telephone Number	:	319-354-1409
Fax Number	:	319-354-3113

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. PAMELA RUTH PUMP
Credential	:	CDA,RDA
Telephone Number	:	319-354-1409

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	08/22/2020

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