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General NPI Number Information
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NPI Number | 1740649912
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Entity Type | Organization
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Legal Business Name | DESIGN DENTAL, INC.
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Dates
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Enumeration Date | 02/17/2016
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Last Update Date | 02/17/2016
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Provider Practice Location Address
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Address Line | 115 N. HWY 965
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City | NORTH LIBERTY
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State | IA
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Zip | 52317
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Country | US
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Telephone | 319-626-2222
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Fax | 319-626-6610
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Provider Business Mailing Address
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Address Line | 115 N. HWY 965 PO BOX 915
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City | NORTH LIBERTY
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State | IA
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Zip | 52317
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Country | US
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Telephone | 319-626-2222
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Fax | 319-626-6610
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Authorized Official
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Title or Position | OWNER
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Name | DR. SHIN-ING JEREMY TU
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Credential | DDS
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Telephone | 319-626-2222
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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 | 207719
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License Number State | IA
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