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General NPI Number Information
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NPI Number | 1770040818
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Entity Type | Organization
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Legal Business Name | LAWHEAD FAMILY DENTISTRY
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Dates
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Enumeration Date | 02/25/2019
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Last Update Date | 02/25/2019
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Provider Practice Location Address
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Address Line | 315 SYCAMORE ST
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City | MUSCATINE
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State | IA
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Zip | 52761-3824
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Country | US
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Telephone | 563-263-8034
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Fax | 563-288-1653
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Provider Business Mailing Address
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Address Line | 315 SYCAMORE ST
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City | MUSCATINE
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State | IA
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Zip | 52761-3824
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Country | US
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Telephone | 563-263-8034
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Fax | 563-288-1653
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Authorized Official
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Title or Position | OFFICE SUPPORT
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Name | JESSICA S ODEGARD
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Credential |
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Telephone | 563-263-8034
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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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