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General NPI Number Information
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NPI Number | 1710054994
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Entity Type | Organization
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Legal Business Name | ABLM NORTHEAST PROFESIONAL ASSOCIATION
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Dates
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Enumeration Date | 11/30/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2116 LOGAN AVE
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City | WATERLOO
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State | IA
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Zip | 50703-1006
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Country | US
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Telephone | 319-235-1151
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Fax | 319-235-2804
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Provider Business Mailing Address
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Address Line | 2116 LOGAN AVE
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City | WATERLOO
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State | IA
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Zip | 50703-1006
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Country | US
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Telephone | 319-235-1151
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Fax | 319-235-2804
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Authorized Official
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Title or Position | PARTNER
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Name | DR. MARVIN C. VORE
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Credential | DDS
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Telephone | 319-235-1151
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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