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General NPI Number Information
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NPI Number | 1750773172
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Entity Type | Organization
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Legal Business Name | ARCTIC DENTAL, PLC
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Dates
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Enumeration Date | 02/22/2015
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Last Update Date | 07/10/2015
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Provider Practice Location Address
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Address Line | 2023 CEDAR PLAZA DR
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City | MUSCATINE
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State | IA
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Zip | 52761-2283
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Country | US
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Telephone | 563-607-5979
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Fax |
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Provider Business Mailing Address
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Address Line | 2023 CEDAR PLAZA DR
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City | MUSCATINE
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State | IA
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Zip | 52761-2283
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Country | US
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Telephone | 563-607-5979
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Fax |
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Authorized Official
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Title or Position | GENERAL MANAGER
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Name | DR. JAROD WILLIAM JOHNSON
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Credential | DDS
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Telephone | 563-607-5979
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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-09044
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License Number State | IA
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