Healthcare Provider Details

I. General information

NPI: 1962534446
Provider Name (Legal Business Name): MIDWEST ORAL & FACIAL SURGERY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2007
Last Update Date: 07/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 JORDAN CREEK PKWY STE. 120
WEST DES MOINES IA
50266-2345
US

IV. Provider business mailing address

1225 JORDAN CREEK PKWY STE. 120
WEST DES MOINES IA
50266-2345
US

V. Phone/Fax

Practice location:
  • Phone: 515-221-0807
  • Fax: 515-221-0816
Mailing address:
  • Phone: 515-221-0807
  • Fax: 515-221-0816

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number8032
License Number StateIA

VIII. Authorized Official

Name: DR. PETER DAVID LEMON
Title or Position: PRESIDENT
Credential: D.M.D., M.D.
Phone: 515-221-0807