Healthcare Provider Details

I. General information

NPI: 1659200996
Provider Name (Legal Business Name): CEDAR RAPIDS DENTAL ENTERPRISES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2026
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1260 3RD AVE SE
CEDAR RAPIDS IA
52403-4083
US

IV. Provider business mailing address

3020 AURORA AVE
SPIRIT LAKE IA
51360-7097
US

V. Phone/Fax

Practice location:
  • Phone: 608-289-2540
  • Fax:
Mailing address:
  • Phone: 608-289-2540
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. SHAUN O'NEILL
Title or Position: OWNER/CEO
Credential: DDS
Phone: 608-289-2540