Individual
JYOTI PRAKASH CHOWDHURY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
BDS
Contact information
Practice address
239 E SAN MARNAN DR, WATERLOO, IA 50702-5839
(319) 321-5075
(319) 234-2882
Mailing address
239 E SAN MARNAN DR, WATERLOO, IA 50702-5839
(319) 321-5075
(319) 234-2882
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
08281
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0076372
—
IA
Enumeration date
12/08/2005
Last updated
07/21/2008
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