Healthcare Provider Details

I. General information

NPI: 1598849093
Provider Name (Legal Business Name): MICHAEL CLARENCE KAYSER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3534 LAFAYETTE RD
EVANSDALE IA
50707-1025
US

IV. Provider business mailing address

3534 LAFAYETTE RD
EVANSDALE IA
50707-1025
US

V. Phone/Fax

Practice location:
  • Phone: 319-233-9903
  • Fax: 319-292-1696
Mailing address:
  • Phone: 319-233-9903
  • Fax: 319-292-1696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number5699
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: