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General NPI Number Information
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NPI Number | 1689201154
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Entity Type | Organization
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Legal Business Name | R&D DENTAL PLC
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Dates
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Enumeration Date | 03/25/2020
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Last Update Date | 03/25/2020
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Provider Practice Location Address
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Address Line | 8515 DOUGLAS AVE
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City | URBANDALE
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State | IA
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Zip | 50322-2915
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Country | US
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Telephone | 515-512-5339
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Fax |
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Provider Business Mailing Address
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Address Line | 14031 WILLOW DR
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City | CLIVE
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State | IA
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Zip | 50325-8317
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Country | US
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Telephone | 205-617-7417
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | RAJENDAR MATTA
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Credential |
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Telephone | 205-617-7417
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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 |
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License Number State |
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