MEDICARE: KINGDOM DENTAL CARE

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	:	1619852423
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KINGDOM DENTAL CARE

Provider Business Mailing Address
First Line	:	804 12TH ST
Second Line	:
City	:	BELLE PLAINE
State	:	IA
Zip	:	52208-1709
Country	:	US
Telephone Number	:	319-444-3343
Fax Number	:	319-444-2607

Provider Business Practice Location Address
First Line	:	804 12TH ST
Second Line	:
City	:	BELLE PLAINE
State	:	IA
Zip	:	52208-1709
Country	:	US
Telephone Number	:	319-444-3343
Fax Number	:	319-444-2607

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	DANIEL DUROSEAU
Credential	:	DDS
Telephone Number	:	951-204-3651

Provider Enumeration Date	:	08/11/2025
Last Update Date	:	08/11/2025

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Directions to “KINGDOM DENTAL CARE ” Practice Location

Language	Start Address	Practice Location

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