MEDICARE: CENTER POINT FAMILY DENTISTRY PLLC

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	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1902209976
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTER POINT FAMILY DENTISTRY PLLC

Provider Business Mailing Address
First Line	:	907 BANK COURT
Second Line	:
City	:	CENTER POINT
State	:	IA
Zip	:	52213-9337
Country	:	US
Telephone Number	:	319-849-1171
Fax Number	:	319-849-2453

Provider Business Practice Location Address
First Line	:	907 BANK COURT
Second Line	:
City	:	CENTER POINT
State	:	IA
Zip	:	52213-9337
Country	:	US
Telephone Number	:	319-849-1171
Fax Number	:	319-849-2453

Authorized Official
Title or Position	:	OWNER/PARTNER
Name	:	DR. TERRA KATHLEEN HICKEY
Credential	:	DDS
Telephone Number	:	319-849-1171

Provider Enumeration Date	:	10/03/2014
Last Update Date	:	02/16/2022

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