Healthcare Provider Details

I. General information

NPI: 1437689940
Provider Name (Legal Business Name): MEDI-DENT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 15TH ST. S.W. SUITE 2
MASON CITY IA
50401
US

IV. Provider business mailing address

1050 15TH ST SW STE 2
MASON CITY IA
50401-5677
US

V. Phone/Fax

Practice location:
  • Phone: 641-450-0281
  • Fax: 641-450-0284
Mailing address:
  • Phone: 641-450-0281
  • Fax: 641-450-0284

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. FRANCIS J CONNELLY
Title or Position: PARTNER/OWNER
Credential:
Phone: 641-450-0281