Healthcare Provider Details

I. General information

NPI: 1194630871
Provider Name (Legal Business Name): COTTAGE GROVE DENTAL CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 S 11TH ST
MARION IA
52302-4962
US

IV. Provider business mailing address

675 S 11TH ST
MARION IA
52302-4962
US

V. Phone/Fax

Practice location:
  • Phone: 319-377-9877
  • Fax:
Mailing address:
  • Phone: 319-377-9877
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW SIEVERDING
Title or Position: CEO CLINICAL DIRECTOR
Credential: DDS
Phone: 319-440-7584