MEDICARE: IRIS DENTAL PC

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	:	1538286794
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IRIS DENTAL PC

Provider Business Mailing Address
First Line	:	PO BOX 340
Second Line	:
City	:	WEST POINT
State	:	IA
Zip	:	52656
Country	:	US
Telephone Number	:	319-837-6502
Fax Number	:	319-385-4681

Provider Business Practice Location Address
First Line	:	706 AVE C
Second Line	:
City	:	WEST POINT
State	:	IA
Zip	:	52656
Country	:	US
Telephone Number	:	319-837-6502
Fax Number	:	319-385-4681

Authorized Official
Title or Position	:	VICE PRESIDENT IRIS DENTAL PC
Name	:	DR. MICHAEL C FITZPATRICK
Credential	:	DMD
Telephone Number	:	319-385-4680

Provider Enumeration Date	:	03/23/2007
Last Update Date	:	08/22/2020

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