MEDICARE: GARNER FAMILY DENTAL

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	08651	IA

General Provider Information

NPI Number	:	1558884684
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GARNER FAMILY DENTAL

Provider Business Mailing Address
First Line	:	3416 161ST ST
Second Line	:
City	:	URBANDALE
State	:	IA
Zip	:	50323-2590
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3311 SW 9TH ST STE 200
Second Line	:
City	:	DES MOINES
State	:	IA
Zip	:	50315-7677
Country	:	US
Telephone Number	:	515-243-7641
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	CORY GARNER
Credential	:
Telephone Number	:	515-720-3692

Provider Enumeration Date	:	07/20/2017
Last Update Date	:	07/20/2017

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Directions to “GARNER FAMILY DENTAL ” Practice Location

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