Healthcare Provider Details

I. General information

NPI: 1649358565
Provider Name (Legal Business Name): DRS POWERS & PAS DDS PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNITS 5 & 6 LAKELAND SQUARE
MILFORD IA
51351
US

IV. Provider business mailing address

PO BOX 141
MILFORD IA
51351-0141
US

V. Phone/Fax

Practice location:
  • Phone: 712-338-2449
  • Fax: 712-338-4239
Mailing address:
  • Phone: 712-338-2449
  • Fax: 712-338-4239

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number6588
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number7716
License Number StateIA

VIII. Authorized Official

Name: DR. RANDY JOSEPH PAS
Title or Position: DENTIST
Credential: DDS
Phone: 712-338-2449