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General NPI Number Information
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NPI Number | 1639486285
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Entity Type | Organization
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Legal Business Name | FRIENDLY DENTAL
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Dates
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Enumeration Date | 09/02/2010
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Last Update Date | 09/02/2010
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Provider Practice Location Address
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Address Line | 611 3RD AVE
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City | SIBLEY
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State | IA
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Zip | 51249-1626
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Country | US
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Telephone | 712-754-2288
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Fax | 712-754-4865
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Provider Business Mailing Address
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Address Line | 611 3RD AVE
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City | SIBLEY
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State | IA
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Zip | 51249-1626
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Country | US
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Telephone | 712-754-2288
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Fax | 712-754-4865
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. JARI L JOHNSON
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Credential |
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Telephone | 507-376-5525
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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 | 07092
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License Number State | IA
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