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NPI Code Detail

MEDICARE: IOWA ORAL AND MAXILLOFACIAL SURGEONS, PC

MEDICARE: IOWA ORAL AND MAXILLOFACIAL SURGEONS, PC
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
11223P0106XOral and Maxillofacial Pathology Dentistry06447IA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
122178OTHERIAMEDICARE PTAN

General Provider Information

NPI Number : 1609846583
Entity Type Code : Organization
Provider Name (Legal Business Name) : IOWA ORAL AND MAXILLOFACIAL SURGEONS, PC
Provider Business Mailing Address
First Line : 1469 29TH ST
Second Line :
City : WEST DES MOINES
State : IA
Zip : 50266-1302
Country : US
Telephone Number : 515-223-6529
Fax Number : 515-223-5448
Provider Business Practice Location Address
First Line : 1469 29TH ST
Second Line :
City : WEST DES MOINES
State : IA
Zip : 50266-1302
Country : US
Telephone Number : 515-223-6529
Fax Number : 515-223-5448
Authorized Official
Title or Position : INSURANCE COORDINATOR
Name : MS. DIANA GAIL WEIRICH
Credential :
Telephone Number : 515-327-1647
Provider Enumeration Date : 01/24/2006
Last Update Date : 05/30/2008

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