Organization Name: | ORAL HEALTH CLINIC PC |
NPI Number: | 1053579201 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | CHADWICK AARON JOHNSON (PRESIDENT) |
Mailing Address: | 1225 Copper Creek Dr Suite K Pleasant Hill |
State: | IA US |
Postal Code: | 503277091 |
Phone Number: | 5152663700 |
Fax Number: | 5152663597 |
NPI Enumeration Date: | 05/23/2008 |
NPI Last Update Date: | 05/23/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QD0000X |
License Number: | 8353 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IA |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Dental |
Taxonomy Definition: |