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General NPI Number Information
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NPI Number | 1982919239
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Entity Type | Individual
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Provider Name | JEREMIAH LEE PHAMS D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 08/11/2010
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Last Update Date | 08/11/2010
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Provider Practice Location Address
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Address Line | 1905 S MARSHALL ST
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City | BOONE
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State | IA
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Zip | 50036-5401
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Country | US
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Telephone | 515-432-9338
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Fax |
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Provider Business Mailing Address
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Address Line | 4224 NEWLAND DR
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City | CEDAR FALLS
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State | IA
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Zip | 50613-1635
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Country | US
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Telephone | 319-202-5061
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 08766
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License Number State | IA
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