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NPI Code Detail

MEDICARE: AESTHETIC & FAMILY DENTRISTRY

MEDICARE: AESTHETIC & FAMILY DENTRISTRY
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
11223G0001XGeneral Practice Dentistry

General Provider Information

NPI Number : 1255597498
Entity Type Code : Organization
Provider Name (Legal Business Name) : AESTHETIC & FAMILY DENTRISTRY
Provider Business Mailing Address
First Line : 119 S ELM ST
Second Line :
City : SHENANDOAH
State : IA
Zip : 51601-1701
Country : US
Telephone Number : 712-246-5587
Fax Number :
Provider Business Practice Location Address
First Line : 119 S ELM ST
Second Line :
City : SHENANDOAH
State : IA
Zip : 51601-1701
Country : US
Telephone Number : 712-246-5587
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : AARON L MCCORMICK
Credential : D.D.S.
Telephone Number : 712-246-5587
Provider Enumeration Date : 08/06/2008
Last Update Date : 08/06/2008

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Directions to “AESTHETIC & FAMILY DENTRISTRY ” Practice Location

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