MEDICARE: IOWA DENTAL HEALTH PROFESSIONALS, P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1346630654
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IOWA DENTAL HEALTH PROFESSIONALS, P.C.

Provider Business Mailing Address
First Line	:	5738 SUNNYBROOK DR
Second Line	:
City	:	SIOUX CITY
State	:	IA
Zip	:	51106-4249
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5738 SUNNYBROOK DR
Second Line	:
City	:	SIOUX CITY
State	:	IA
Zip	:	51106-4249
Country	:	US
Telephone Number	:	217-540-5141
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING
Name	:	CARMEN WOODS
Credential	:
Telephone Number	:	712-522-3274

Provider Enumeration Date	:	01/26/2015
Last Update Date	:	01/26/2015

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