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General NPI Number Information
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NPI Number | 1154779775
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Entity Type | Organization
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Legal Business Name | DENTAL CENTER OF NORTH IOWA LC
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Dates
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Enumeration Date | 05/25/2016
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Last Update Date | 05/25/2016
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Provider Practice Location Address
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Address Line | 2800 4TH ST SW SUITE 1
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City | MASON CITY
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State | IA
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Zip | 50401-1596
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Country | US
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Telephone | 641-424-8062
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Fax |
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Provider Business Mailing Address
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Address Line | 2800 4TH ST SW SUITE 1
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City | MASON CITY
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State | IA
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Zip | 50401-1596
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Country | US
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Telephone | 641-424-8062
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICHAEL LOUSCHER
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Credential |
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Telephone | 641-424-8062
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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 | 7831
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License Number State | IA
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