Healthcare Provider Details

I. General information

NPI: 1235396946
Provider Name (Legal Business Name): NORTHERNN IOWA ENDODONTICS PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2008
Last Update Date: 05/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1810 W 8TH ST SUITE A
CEDAR FALLS IA
50613-2071
US

IV. Provider business mailing address

1810 W 8TH ST SUITE A
CEDAR FALLS IA
50613-2071
US

V. Phone/Fax

Practice location:
  • Phone: 319-266-7110
  • Fax: 319-266-7112
Mailing address:
  • Phone: 319-266-7110
  • Fax: 319-266-7112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number7381
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. JON J JUHLIN
Title or Position: DDS
Credential:
Phone: 319-266-7110