Healthcare Provider Details

I. General information

NPI: 1578095097
Provider Name (Legal Business Name): ADVANCED PERIODONTICS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2017
Last Update Date: 04/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 MCKENZIE AVE SUITE 207
COUNCIL BLUFFS IA
51503-1002
US

IV. Provider business mailing address

PO BOX 189
COUNCIL BLUFFS IA
51502-0189
US

V. Phone/Fax

Practice location:
  • Phone: 712-435-0992
  • Fax: 402-552-2330
Mailing address:
  • Phone: 712-435-0992
  • Fax: 402-552-2330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number StateIA

VIII. Authorized Official

Name: DR. SIMA ZITOUNI
Title or Position: PERIODONTIST
Credential: DDS
Phone: 402-651-9341