=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124248489
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOHN ROHLOFF
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/27/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2335 HWY 92 E
-----------------------------------------------------
City | OSKALOOSA
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 52577
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 641-673-8455
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 400 NEW PRESTON DRIVE
-----------------------------------------------------
City | OSKALOOSA
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 52577
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 641-673-8460
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 7080
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------