Healthcare Provider Details

I. General information

NPI: 1548991987
Provider Name (Legal Business Name): EMILY ANNE DALLUGE DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2022
Last Update Date: 07/25/2022
Certification Date: 06/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 HIGHWAY 218 N
LA PORTE CITY IA
50651-1009
US

IV. Provider business mailing address

3626 LORALIN DR
WATERLOO IA
50701-4812
US

V. Phone/Fax

Practice location:
  • Phone: 319-342-3622
  • Fax:
Mailing address:
  • Phone: 319-239-5948
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDDS-09987
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: