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General NPI Number Information
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NPI Number | 1245800531
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Entity Type | Organization
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Legal Business Name | MJB HOLDINGS PLLC
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Dates
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Enumeration Date | 06/29/2021
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Last Update Date | 06/29/2021
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Provider Practice Location Address
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Address Line | 2153 SE LA GRANT PKWY
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City | WAUKEE
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State | IA
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Zip | 50263-7605
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Country | US
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Telephone | 515-644-2264
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Fax |
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Provider Business Mailing Address
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Address Line | 2153 SE LA GRANT PKWY
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City | WAUKEE
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State | IA
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Zip | 50263-7605
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Country | US
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Telephone | 515-644-2264
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | JASON BROWN
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Credential |
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Telephone | 515-344-8671
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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