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General NPI Number Information
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NPI Number | 1255598496
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Entity Type | Organization
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Legal Business Name | DENTAL ASSOCIATES
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Dates
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Enumeration Date | 05/16/2008
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Last Update Date | 05/16/2008
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Provider Practice Location Address
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Address Line | 101 N BROADWAY AVE
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City | NEW HAMPTON
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State | IA
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Zip | 50659-1108
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Country | US
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Telephone | 641-394-2137
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Fax | 641-394-2138
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Provider Business Mailing Address
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Address Line | 101 N BROADWAY AVE
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City | NEW HAMPTON
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State | IA
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Zip | 50659-1108
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Country | US
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Telephone | 641-394-2137
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Fax | 641-394-2138
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | MRS. DIANA LYNN PEARCE
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Credential |
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Telephone | 641-394-2137
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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 | 6997
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License Number State | IA
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