# WESTERN IOWA DENTAL GROUP,PC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** WESTERN IOWA DENTAL GROUP, PC
- **Other names:** Bayliss Park Dental Group
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1073939799
- **Legal business name:** WESTERN IOWA DENTAL GROUP, PC
- **Authorized official:** MRS. BETTY KERGER (OFFICE MANAGER)
- **Authorized official phone:** (712) 325-1544

## Contact information

- **Practice address:** 114 1/2 S 6TH ST, COUNCIL BLUFFS, IA 51501-4234
- **Practice address phone:** (712) 325-1544
- **Practice address fax:** (712) 325-0420
- **Mailing address:** 1509 AVENUE G, COUNCIL BLUFFS, IA 51501-2516
- **Mailing address phone:** (712) 325-1544
- **Mailing address fax:** (712) 325-0420

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 07421 | IA | Yes |

## Other

- **Enumeration date:** 03/06/2014
- **Last updated:** 03/06/2014