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General NPI Number Information
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NPI Number | 1013645738
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Entity Type | Organization
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Legal Business Name | UPLIFT FAMILY DENTISTRY LLC
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Dates
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Enumeration Date | 08/10/2022
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Last Update Date | 08/10/2022
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Provider Practice Location Address
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Address Line | 1700 E SUMMIT ST
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City | RED OAK
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State | IA
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Zip | 51566-1711
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Country | US
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Telephone | 712-623-5404
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Fax | 712-623-5231
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Provider Business Mailing Address
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Address Line | 101 NORTHWEST RD
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City | IMOGENE
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State | IA
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Zip | 51645-4047
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Country | US
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Telephone | 402-881-9378
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Fax |
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Authorized Official
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Title or Position | DENTIST OWNER
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Name | DR. CARLA KUCIREK
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Credential | DDS
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Telephone | 712-623-5404
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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