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General NPI Number Information
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NPI Number | 1992962732
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Entity Type | Organization
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Legal Business Name | EASTERN IOWA ORAL AND MAXILLOFACIAL SURGERY
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Dates
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Enumeration Date | 05/20/2008
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Last Update Date | 12/28/2021
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Provider Practice Location Address
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Address Line | 4150 EDGEWOOD ROAD NE SUITE 100
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City | CEDAR RAPIDS
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State | IA
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Zip | 52402-0609
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Country | US
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Telephone | 319-366-8277
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Fax | 319-366-7091
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Provider Business Mailing Address
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Address Line | 4150 EDGEWOOD ROAD NE SUITE 100
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City | CEDAR RAPIDS
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State | IA
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Zip | 52402-0609
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Country | US
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Telephone | 319-366-8277
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Fax | 319-366-7091
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. SUZANNE J. STEWART
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Credential |
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Telephone | 319-366-8277
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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 | 08986
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License Number State | IA
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