Organization
MISSOURI VALLEY DENTAL GROUP, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEAN KERGER (CORPORATION MANAGER)
(712) 642-4136
Entity
Organization
Contact information
Practice address
214 E ERIE ST, MISSOURI VALLEY, IA 51555-1533
(712) 642-4136
(712) 642-3664
Mailing address
214 E ERIE ST, MISSOURI VALLEY, IA 51555-1533
(712) 642-4136
(712) 642-3664
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
07421
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0492033
—
IA
05
—
2152637
—
IA
05
—
5264622
—
IA
05
—
6060053
—
IA
Enumeration date
08/05/2007
Last updated
08/05/2007
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