Healthcare Provider Details

I. General information

NPI: 1356498596
Provider Name (Legal Business Name): PETER WILLIAM PALS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

322 ALBANY AVE SE BOX 167
ORANGE CITY IA
51041-1626
US

IV. Provider business mailing address

322 ALBANY AVE SE BOX 167
ORANGE CITY IA
51041-1626
US

V. Phone/Fax

Practice location:
  • Phone: 712-737-2931
  • Fax:
Mailing address:
  • Phone: 712-737-2931
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number5397
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: