Healthcare Provider Details

I. General information

NPI: 1205019296
Provider Name (Legal Business Name): DRS KOMMER AND STURDIVANT PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2007
Last Update Date: 12/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 VALLEY WEST DRIVE
WEST DES MOINES IA
50265-3939
US

IV. Provider business mailing address

125 VALLEY WEST DRIVE
WEST DES MOINES IA
50265-3939
US

V. Phone/Fax

Practice location:
  • Phone: 515-225-9245
  • Fax: 515-225-8162
Mailing address:
  • Phone: 515-225-9245
  • Fax: 515-225-8162

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number StateIA

VIII. Authorized Official

Name: DR. DENNIS D KOMMER
Title or Position: ORTHODONTIST
Credential: DDS MS
Phone: 515-225-9245