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General NPI Number Information
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NPI Number | 1184072555
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Entity Type | Organization
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Legal Business Name | AMES CENTER FOR COSMETIC AND FAMILY DENTISTRY PC
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Dates
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Enumeration Date | 05/26/2016
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Last Update Date | 10/12/2016
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Provider Practice Location Address
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Address Line | 415 S DUFF AVE STE D
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City | AMES
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State | IA
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Zip | 50010-6600
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Country | US
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Telephone | 515-956-3700
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Fax | 515-956-4232
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Provider Business Mailing Address
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Address Line | 415 S DUFF AVE STE D
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City | AMES
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State | IA
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Zip | 50010-6600
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Country | US
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Telephone | 515-956-3700
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Fax | 515-956-4232
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. AMIE J. ROCKOW-NELSON
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Credential | DDS
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Telephone | 515-956-3700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number | 08059
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License Number State | IA
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