Organization
BRUCE A D'AGOSTINO DDS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRUCE ANTHONY D'AGOSTINO DDS (PRESIDENT)
(563) 652-3811
Entity
Organization
Contact information
Practice address
402 W PLATT ST, MAQUOKETA, IA 52060-2161
(563) 652-3811
(563) 652-3187
Mailing address
402 W PLATT ST, MAQUOKETA, IA 52060-2161
(563) 652-3811
(563) 652-3187
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
6471
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1164376
—
LA
Enumeration date
05/15/2008
Last updated
05/15/2008
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