MEDICARE: IOWA CITY DENTAL HOLDING COMPANY PLC

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1366335804
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IOWA CITY DENTAL HOLDING COMPANY PLC

Provider Business Mailing Address
First Line	:	2867 HICKORY TRL
Second Line	:
City	:	IOWA CITY
State	:	IA
Zip	:	52245-3538
Country	:	US
Telephone Number	:	319-321-0100
Fax Number	:

Provider Business Practice Location Address
First Line	:	2109 ROCHESTER AVE
Second Line	:
City	:	IOWA CITY
State	:	IA
Zip	:	52245-3528
Country	:	US
Telephone Number	:	319-338-0707
Fax Number	:

Authorized Official
Title or Position	:	GENERAL DENTIST
Name	:	GLENN YOWELL
Credential	:	DDS
Telephone Number	:	319-338-0707

Provider Enumeration Date	:	06/02/2025
Last Update Date	:	06/02/2025

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