| Organization Name: | CORRIDOR ENDODONTICS PC |
| NPI Number: | 1326454042 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | BEN JORGENSEN (OWNER) |
| Mailing Address: | 550 Pond View Dr Suite 2 North Liberty |
| State: | IA US |
| Postal Code: | 523172507 |
| Phone Number: | 3194591975 |
| Fax Number: | 3194591977 |
| NPI Enumeration Date: | 07/02/2014 |
| NPI Last Update Date: | 07/02/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | 09095 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IA |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |