Healthcare Provider Details

I. General information

NPI: 1215858675
Provider Name (Legal Business Name): CHILDREN'S DENTAL CENTER OF SOUTHEAST IOWA, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 LAYNE DR
WEST BURLINGTON IA
52655-1060
US

IV. Provider business mailing address

409 LAYNE DR
WEST BURLINGTON IA
52655-1060
US

V. Phone/Fax

Practice location:
  • Phone: 319-752-1444
  • Fax: 319-752-8468
Mailing address:
  • Phone: 319-752-1444
  • Fax: 319-752-8468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL STEVEN MATHEWS
Title or Position: OWNER/PEDIATRIC DENTIST
Credential: DDS
Phone: 319-752-1444