Healthcare Provider Details

I. General information

NPI: 1891860490
Provider Name (Legal Business Name): JOEL M WALSWORTH DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 20TH ST NW
WAVERLY IA
50677
US

IV. Provider business mailing address

121 20TH ST NW
WAVERLY IA
50677
US

V. Phone/Fax

Practice location:
  • Phone: 319-352-5281
  • Fax: 319-352-0509
Mailing address:
  • Phone: 319-352-5281
  • Fax: 319-352-0509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number8370
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number8370
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: