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General NPI Number Information
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NPI Number | 1245656800
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Entity Type | Organization
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Legal Business Name | IOWA PEDIATRIC DENTAL CENTER II LLC
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Dates
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Enumeration Date | 03/06/2014
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Last Update Date | 03/06/2014
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Provider Practice Location Address
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Address Line | 5350 KIRKWOOD BLVD SW SUITE 700
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City | CEDAR RAPIDS
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State | IA
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Zip | 52404-5233
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Country | US
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Telephone | 319-366-0600
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Fax | 319-366-1316
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Provider Business Mailing Address
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Address Line | 5350 KIRKWOOD BLVD SW SUITE 700
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City | CEDAR RAPIDS
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State | IA
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Zip | 52404-5233
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Country | US
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Telephone | 319-366-0600
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Fax | 319-366-1316
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Authorized Official
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Title or Position | DOCTOR/OWNER
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Name | DR. DONALD CRAIG PETERSON JR.
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Credential | D.D.S.
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Telephone | 319-366-0600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 08193
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License Number State | IA
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