| Stater Dental | |
|
112 N 10th St Centerville IA 52544-1730 | |
| (641) 856-8643 | |
| Not Available |
| Full Name | Stater Dental |
|---|---|
| Speciality | Dentist |
| Location | 112 N 10th St, Centerville, Iowa |
| Authorized Official Name and Position | Craig Douglas Stater (DENTIST) |
| Authorized Official Contact | 6418568643 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Stater Dental 112 N 10th St Centerville IA 52544-1730 Ph: (641) 856-8643 | Stater Dental 112 N 10th St Centerville IA 52544-1730 Ph: (641) 856-8643 |
| NPI Number | 1720478878 |
|---|---|
| Provider Enumeration Date | 01/28/2015 |
| Last Update Date | 01/28/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720478878 | NPI | - | NPPES |
| 1821160755 | Medicaid | IA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | DDS-06366 (Iowa) | Primary |
Ron M. Harshman, Dds Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 501 W Jackson St, Centerville, IA 52544 Phone: 641-856-5352 Fax: 641-856-2770 |