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General NPI Number Information
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NPI Number | 1508023375
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Entity Type | Organization
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Legal Business Name | PEOSTA DENTAL
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Dates
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Enumeration Date | 05/20/2008
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Last Update Date | 05/20/2008
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Provider Practice Location Address
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Address Line | 8558 KAPP DR
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City | PEOSTA
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State | IA
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Zip | 52068-9759
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Country | US
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Telephone | 563-557-1563
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Fax | 563-583-0581
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Provider Business Mailing Address
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Address Line | 8558 KAPP DR
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City | PEOSTA
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State | IA
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Zip | 52068-9759
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Country | US
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Telephone | 563-557-1563
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Fax | 563-583-0581
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Authorized Official
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Title or Position | DENTIST
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Name | DR. AUSTIN BARRETT REED
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Credential | D.D.S
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Telephone | 563-557-1563
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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 | 08417
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License Number State | IA
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