Healthcare Provider Details

I. General information

NPI: 1114905387
Provider Name (Legal Business Name): STATE UNIVERSITY OF IOWA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2006
Last Update Date: 02/28/2025
Certification Date: 02/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HAWKINS DRIVE 51300 POMERANTZ FAMILY PAVILION
IOWA CITY IA
52242-1049
US

IV. Provider business mailing address

200 HAWKINS DRIVE 51300 POMERANTZ FAMILY PAVILION
IOWA CITY IA
52242-1049
US

V. Phone/Fax

Practice location:
  • Phone: 319-356-2743
  • Fax: 319-353-6923
Mailing address:
  • Phone: 319-356-2743
  • Fax: 319-353-6923

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: PAULINA JANCZUK
Title or Position: ASSISTANT DEAN FINANCIAL AFFAIRS
Credential: BBA MPH
Phone: 319-467-0735