Organization
PEDIATRIC DENTRISTRY OF CORALVILLE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. POLLY IBEN DDS (OWNER)
(319) 338-7520
Entity
Organization
Contact information
Practice address
414 10TH AVE, STE B, CORALVILLE, IA 52241
(319) 338-7520
(319) 351-5730
Mailing address
414 10TH AVE, STE B, CORALVILLE, IA 52241
(319) 338-7520
(319) 351-5730
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
07894
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2188144
—
IA
Enumeration date
08/02/2006
Last updated
08/22/2020
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