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General NPI Number Information
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NPI Number | 1841324084
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Entity Type | Organization
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Legal Business Name | FORT DODGE ORAL AND MAXILLOFACIAL SURGERY LLP
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Dates
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Enumeration Date | 03/16/2007
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Last Update Date | 12/29/2017
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Provider Practice Location Address
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Address Line | 804 KENYON RD STE 120
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City | FORT DODGE
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State | IA
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Zip | 50501-5742
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Country | US
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Telephone | 515-576-8727
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Fax | 515-576-7076
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Provider Business Mailing Address
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Address Line | 804 KENYON RD STE 120
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City | FORT DODGE
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State | IA
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Zip | 50501-5746
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Country | US
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Telephone | 515-576-8727
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Fax | 515-576-7076
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | ELIZABETH SCHRAUTH
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Credential |
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Telephone | 515-576-8727
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State | IA
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