MEDICARE: MT PLEASANT DENTAL ASSOCIATES, P.C.

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	261QD0000X	Dental Clinic/Center	7586	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417097445
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MT PLEASANT DENTAL ASSOCIATES, P.C.

Provider Business Mailing Address
First Line	:	304 N JEFFERSON ST
Second Line	:
City	:	MT PLEASANT
State	:	IA
Zip	:	52641-1621
Country	:	US
Telephone Number	:	319-385-8912
Fax Number	:	319-385-4532

Provider Business Practice Location Address
First Line	:	304 N JEFFERSON ST
Second Line	:
City	:	MT PLEASANT
State	:	IA
Zip	:	52641-1621
Country	:	US
Telephone Number	:	319-385-8912
Fax Number	:	319-385-4532

Authorized Official
Title or Position	:	OWNER
Name	:	JEFFERY EDWARD SITAR
Credential	:	D.D.S.
Telephone Number	:	319-385-3795

Provider Enumeration Date	:	02/07/2007
Last Update Date	:	08/22/2020

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