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General NPI Number Information
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NPI Number | 1437499605
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Entity Type | Organization
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Legal Business Name | UNIVERSITY OF IOWA COLLEGE OF DENTISTRY
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Dates
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Enumeration Date | 02/25/2013
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Last Update Date | 02/25/2013
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Provider Practice Location Address
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Address Line | 801 NEWTON ROAD 313 DSB S
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City | IOWA CITY
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State | IA
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Zip | 52242
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Country | US
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Telephone | 319-335-7322
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Fax |
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Provider Business Mailing Address
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Address Line | 4333 PINE RIDGE TRL NE
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City | IOWA CITY
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State | IA
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Zip | 52240-7831
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Country | US
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Telephone | 319-351-0442
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Fax |
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Authorized Official
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Title or Position | DEAN OF COLLEGE OF DENTISTRY
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Name | DAVID JOHNSEN
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Credential | DDS
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Telephone | 319-335-7144
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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 | 04869
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License Number State | IA
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