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General NPI Number Information
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NPI Number | 1205907896
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Entity Type | Organization
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Legal Business Name | DES MOINES DENTAL GROUP
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Dates
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Enumeration Date | 11/13/2006
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Last Update Date | 03/09/2009
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Provider Practice Location Address
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Address Line | 8515 DOUGLAS AVE SUITE 21
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City | DES MOINES
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State | IA
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Zip | 50322-2924
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Country | US
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Telephone | 515-278-2361
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Fax | 515-276-9233
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Provider Business Mailing Address
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Address Line | 8515 DOUGLAS AVE SUITE 21
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City | DES MOINES
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State | IA
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Zip | 50322-2924
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Country | US
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Telephone | 515-278-2361
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Fax | 515-276-9233
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Authorized Official
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Title or Position | GENERAL MANAGER
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Name | MR. JEFF BRANDT
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Credential |
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Telephone | 515-278-2361
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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 |
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License Number State |
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