Healthcare Provider Details

I. General information

NPI: 1215071394
Provider Name (Legal Business Name): NORTH IOWA ORAL SURGERY AND DENTAL IMPLANT CENTER, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 01/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 S MONROE AVE
MASON CITY IA
50401
US

IV. Provider business mailing address

1530 S MONROE AVE
MASON CITY IA
50401
US

V. Phone/Fax

Practice location:
  • Phone: 641-424-1656
  • Fax: 641-424-2219
Mailing address:
  • Phone: 641-424-1656
  • Fax: 641-424-2219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number08489
License Number StateIA
# 3
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number07778
License Number StateIA

VIII. Authorized Official

Name: DR. LYELL R. HOGG
Title or Position: OWNER
Credential: D.D.S.
Phone: 641-424-1656