Healthcare Provider Details

I. General information

NPI: 1104837046
Provider Name (Legal Business Name): DENTAL CONNECTIONS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 10/04/2022
Certification Date: 10/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 9TH ST STE 190
DES MOINES IA
50314-2582
US

IV. Provider business mailing address

1111 9TH ST STE 190
DES MOINES IA
50314-2582
US

V. Phone/Fax

Practice location:
  • Phone: 515-244-9136
  • Fax: 515-244-9153
Mailing address:
  • Phone: 515-244-9136
  • Fax: 515-244-9153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number08207
License Number StateIA

VIII. Authorized Official

Name: CARLY ROSS
Title or Position: PRESIDENT/CEO
Credential:
Phone: 515-244-9136