Healthcare Provider Details

I. General information

NPI: 1235110685
Provider Name (Legal Business Name): DUBUQUE ENT HEAD & NECK SURGERY P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2005
Last Update Date: 07/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 CEDAR CROSS ROAD
DUBUQUE IA
52003-7704
US

IV. Provider business mailing address

535 CEDAR CROSS ROAD
DUBUQUE IA
52003-7704
US

V. Phone/Fax

Practice location:
  • Phone: 563-588-0506
  • Fax: 563-588-0451
Mailing address:
  • Phone: 563-588-0506
  • Fax: 563-588-0451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State

VIII. Authorized Official

Name: THOMAS JAMES BENDA JR.
Title or Position: PARTNER
Credential: M.D.
Phone: 563-588-0506