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General NPI Number Information
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NPI Number | 1316483647
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Entity Type | Organization
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Legal Business Name | BYLSMA-MULDER FAMILY DENTISTRY, P.C.
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Dates
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Enumeration Date | 01/10/2017
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Last Update Date | 01/10/2017
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Provider Practice Location Address
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Address Line | 159 S MAIN AVE
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City | SIOUX CENTER
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State | IA
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Zip | 51250-1535
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Country | US
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Telephone | 712-722-2633
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Fax |
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Provider Business Mailing Address
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Address Line | 159 S MAIN AVE
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City | SIOUX CENTER
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State | IA
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Zip | 51250-1535
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Country | US
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Telephone | 712-722-2633
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | FONDA HULSTEIN
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Credential |
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Telephone | 712-722-2633
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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 | 7596
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License Number State | IA
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