Organization Name: | BRDA PLLC |
NPI Number: | 1144617721 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | AMY N WILKEN-HEYING (OWNER) |
Mailing Address: | 1700 Blairs Ferry Rd Hiawatha |
State: | IA US |
Postal Code: | 522332033 |
Phone Number: | 3193963596 |
Fax Number: | 3193780546 |
NPI Enumeration Date: | 04/21/2015 |
NPI Last Update Date: | 04/21/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QD0000X |
License Number: | DDS-08160 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IA |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Dental |
Taxonomy Definition: |