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General NPI Number Information
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NPI Number | 1134109739
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Entity Type | Organization
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Legal Business Name | DENTAL ASSOCIATES OF MANCHESTER
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Dates
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Enumeration Date | 01/19/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 120 E FAYETTE ST
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City | MANCHESTER
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State | IA
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Zip | 52057-1705
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Country | US
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Telephone | 563-927-4746
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Fax | 563-927-6217
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Provider Business Mailing Address
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Address Line | 120 E FAYETTE ST
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City | MANCHESTER
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State | IA
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Zip | 52057-1705
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Country | US
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Telephone | 563-927-4746
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Fax | 563-927-6217
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. CONNIE L BEHNKEN
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Credential | RDA,BS
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Telephone | 563-927-6038
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State | IA
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