Organization Name: | LECLAIRE FAMILY DENTISTRY |
NPI Number: | 1053643460 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MICHAEL STECHER (OWNER) |
Mailing Address: | 126 S Cody Rd Le Claire |
State: | IA US |
Postal Code: | 527539236 |
Phone Number: | 5632893249 |
Fax Number: | |
NPI Enumeration Date: | 02/10/2010 |
NPI Last Update Date: | 02/10/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QD0000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Dental |
Taxonomy Definition: |