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General NPI Number Information
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NPI Number | 1114905387
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Entity Type | Organization
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Legal Business Name | STATE UNIVERSITY OF IOWA
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Dates
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Enumeration Date | 01/06/2006
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Last Update Date | 02/28/2025
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Provider Practice Location Address
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Address Line | 200 HAWKINS DRIVE 51300 POMERANTZ FAMILY PAVILION
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City | IOWA CITY
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State | IA
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Zip | 52242-1049
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Country | US
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Telephone | 319-356-2743
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Fax | 319-353-6923
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Provider Business Mailing Address
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Address Line | 200 HAWKINS DRIVE 51300 POMERANTZ FAMILY PAVILION
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City | IOWA CITY
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State | IA
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Zip | 52242-1049
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Country | US
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Telephone | 319-356-2743
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Fax | 319-353-6923
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Authorized Official
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Title or Position | ASSISTANT DEAN FINANCIAL AFFAIRS
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Name | PAULINA JANCZUK
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Credential | BBA MPH
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Telephone | 319-467-0735
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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Taxonomy #3
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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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