| Prairie Trails Family Dental Llc | |
|
100 E South St Corydon IA 50060-1724 | |
| (641) 872-2514 | |
| (641) 872-1152 |
| Full Name | Prairie Trails Family Dental Llc |
|---|---|
| Speciality | Dentist |
| Location | 100 E South St, Corydon, Iowa |
| Authorized Official Name and Position | Susan Henderson (DIR. ADMINISTRATIVE SERVICES) |
| Authorized Official Contact | 6418725341 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Prairie Trails Family Dental Llc Po Box 284 Corydon IA 50060-0284 Ph: (641) 872-2514 | Prairie Trails Family Dental Llc 100 E South St Corydon IA 50060-1724 Ph: (641) 872-2514 |
| NPI Number | 1336485424 |
|---|---|
| Provider Enumeration Date | 12/18/2012 |
| Last Update Date | 11/18/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336485424 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Primary |
Prairie Trails Family Dental Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 100 E South St, Corydon, IA 50060 Phone: 641-872-2514 |