Facts
- Status
- A
- Credential
- DDS
- Type
- Individual
- Enumeration date
- 2014-07-08
- Last updated
- 2014-07-08
Specialties
Licenses
- License IA
- DDS-09123
Location
- Practice location
- 101 FRANKLIN ST
- City
- MONONA IA
- Postal code
- 521598092
- Phone
- 563-539-4651
Medicare
- PECOS
- A PECOS enrollment row matches this NPI.
LEIE
The OIG NPI list is not in this build yet. Confirm on OIG's search.
Nearby
Search this city from the state hub for other records in the public registry.
Removal request
Public data from NPPES and CMS. Not a credentialing determination.