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General NPI Number Information
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NPI Number | 1336308014
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Entity Type | Organization
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Legal Business Name | INDIANOLA DENTAL ASSOCIATES INC PC
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Dates
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Enumeration Date | 06/06/2008
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Last Update Date | 06/06/2008
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Provider Practice Location Address
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Address Line | 212 NORTH BUXTON
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City | INDIANOLA
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State | IA
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Zip | 50125-2431
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Country | US
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Telephone | 515-961-0534
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Fax |
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Provider Business Mailing Address
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Address Line | 212 NORTH BUXTON
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City | INDIANOLA
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State | IA
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Zip | 50125-2431
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Country | US
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Telephone | 515-961-0534
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DAVID ALAN ZABORAL
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Credential |
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Telephone | 515-961-0534
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 06922
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License Number State | IA
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