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General NPI Number Information
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NPI Number | 1861716599
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Entity Type | Organization
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Legal Business Name | IOWA DENTAL CLINIC, PC
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Dates
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Enumeration Date | 03/24/2010
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Last Update Date | 03/24/2010
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Provider Practice Location Address
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Address Line | 5601 HICKMAN RD SUITE-5
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City | DES MOINES
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State | IA
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Zip | 50310-1163
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Country | US
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Telephone | 515-314-9169
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 22112
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City | CLIVE
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State | IA
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Zip | 50325-9402
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Country | US
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Telephone | 515-314-9169
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. FARIHA BAIG
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Credential | DDS
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Telephone | 515-314-9169
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 08616
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License Number State | IA
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