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General NPI Number Information
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NPI Number | 1700364874
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Entity Type | Organization
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Legal Business Name | SPRINGBROOK FAMILY DENTISTRY, PC
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Dates
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Enumeration Date | 08/01/2018
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Last Update Date | 08/01/2018
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Provider Practice Location Address
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Address Line | 214 STATE ST
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City | GUTHRIE CENTER
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State | IA
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Zip | 50115-1350
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Country | US
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Telephone | 641-332-3100
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Fax |
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Provider Business Mailing Address
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Address Line | 214 STATE ST
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City | GUTHRIE CENTER
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State | IA
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Zip | 50115-1350
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DANIEL AARON NELSON
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Credential | DDS
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Telephone | 515-971-6324
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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 | DDS-09588
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License Number State | IA
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