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General NPI Number Information
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NPI Number | 1700105442
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Entity Type | Organization
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Legal Business Name | CEDAR VALLEY ENDODONTICS, LLC
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Dates
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Enumeration Date | 05/20/2010
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Last Update Date | 10/20/2014
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Provider Practice Location Address
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Address Line | 209 BROOKERIDGE DR
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City | WATERLOO
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State | IA
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Zip | 50702-5703
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Country | US
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Telephone | 319-233-0803
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Fax | 319-233-1945
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Provider Business Mailing Address
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Address Line | 209 BROOKERIDGE DR
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City | WATERLOO
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State | IA
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Zip | 50702-5703
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Country | US
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Telephone | 319-233-0803
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Fax | 319-233-1945
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Authorized Official
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Title or Position | OWNER
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Name | DR. DANIELLE PAIGE WINGROVE
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Credential | DDS
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Telephone | 319-233-0803
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 08295
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License Number State | IA
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