MEDICARE: DR. DAVID JOSEPH VERBIK DDS PHD

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	08163	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	55729	OTHER	IA	WELLMARK

General Provider Information

NPI Number	:	1427168749
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID JOSEPH VERBIK DDS PHD

Provider Business Mailing Address
First Line	:	PO BOX 122
Second Line	:
City	:	LAKE CITY
State	:	IA
Zip	:	51449
Country	:	US
Telephone Number	:	712-464-3124
Fax Number	:	712-464-7479

Provider Business Practice Location Address
First Line	:	1331 WEST MAIN STREET
Second Line	:
City	:	LAKE CITY
State	:	IA
Zip	:	51449
Country	:	US
Telephone Number	:	712-464-3124
Fax Number	:	712-464-7479

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	02/22/2012

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