| Prairie Trails Family Dental | |
|
100 E South St Corydon IA 50060-1724 | |
| (641) 872-2514 | |
| Not Available |
| Full Name | Prairie Trails Family Dental |
|---|---|
| Speciality | Dentist |
| Location | 100 E South St, Corydon, Iowa |
| Authorized Official Name and Position | Susan Henderson (CLINIC ADMINISTRATOR) |
| Authorized Official Contact | 6418722260 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Prairie Trails Family Dental Po Box 284 Corydon IA 50060-0284 Ph: (641) 872-2514 | Prairie Trails Family Dental 100 E South St Corydon IA 50060-1724 Ph: (641) 872-2514 |
| NPI Number | 1326209198 |
|---|---|
| Provider Enumeration Date | 06/24/2008 |
| Last Update Date | 06/24/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326209198 | NPI | - | NPPES |
| 70326 | Other | IA | BLUE CROSS BLUE SHIELD FEDERAL EMPLOYEE PROGRAM |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 08461 (Iowa) | Primary |
Prairie Trails Family Dental Llc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 100 E South St, Corydon, IA 50060 Phone: 641-872-2514 Fax: 641-872-1152 |