Healthcare Provider Details

I. General information

NPI: 1881129906
Provider Name (Legal Business Name): INDIAN HILLS COMMUNITY COLLEGE DENTAL HYGIENE CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2017
Last Update Date: 04/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 GRANDVIEW AVE
OTTUMWA IA
52501-1359
US

IV. Provider business mailing address

525 GRANDVIEW AVENUE
OTTUMWA IA
52501
US

V. Phone/Fax

Practice location:
  • Phone: 641-683-5120
  • Fax:
Mailing address:
  • Phone: 641-683-5120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. JODY LYNN WILLIAMS
Title or Position: DENTAL HYGIENE PROGRAM DIRECTOR
Credential: RDH, MA
Phone: 641-683-5120