| Pediatric Dentristry Of Coralville Inc | |
|
414 10th Ave Ste B Coralville IA 52241 | |
| (319) 338-7520 | |
| (319) 351-5730 |
| Full Name | Pediatric Dentristry Of Coralville Inc |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 414 10th Ave, Coralville, Iowa |
| Authorized Official Name and Position | Polly Iben (OWNER) |
| Authorized Official Contact | 3193387520 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Pediatric Dentristry Of Coralville Inc 414 10th Ave Ste B Coralville IA 52241 Ph: (319) 338-7520 | Pediatric Dentristry Of Coralville Inc 414 10th Ave Ste B Coralville IA 52241 Ph: (319) 338-7520 |
| NPI Number | 1003823113 |
|---|---|
| Provider Enumeration Date | 08/02/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003823113 | NPI | - | NPPES |
| 2188144 | Medicaid | IA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | 07894 (Iowa) | Primary |
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