=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548451628
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DONA W. PRINCE DDS, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/05/2007
-----------------------------------------------------
Last Update Date | 08/05/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4220 SERGEANT RD
-----------------------------------------------------
City | SIOUX CITY
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 51106-4648
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 712-274-2228
-----------------------------------------------------
Fax | 712-274-1362
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4220 SERGEANT RD
-----------------------------------------------------
City | SIOUX CITY
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 51106-4648
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 712-274-2228
-----------------------------------------------------
Fax | 712-274-1362
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | MRS. TERRI PITHAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 712-274-2228
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------