Healthcare Provider Details

I. General information

NPI: 1215034889
Provider Name (Legal Business Name): ORAL SURGERY ASSOC OF IOWA CITY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2006
Last Update Date: 08/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2814 NORTHGATE DR SUITE 2
IOWA CITY IA
52245
US

IV. Provider business mailing address

2814 NORTHGATE DR SUITE 2
IOWA CITY IA
52245-9568
US

V. Phone/Fax

Practice location:
  • Phone: 319-338-5484
  • Fax: 319-338-9413
Mailing address:
  • Phone: 319-338-5484
  • Fax: 319-338-9413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number StateIA

VIII. Authorized Official

Name: DR. ANDREW CHARLES HARTWIG
Title or Position: OWNER
Credential: DDS PHD
Phone: 319-338-5484