Organization
DEWITT FAMILY DENTISTRY P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TRACI PAULSEN D.D.S. (OWNER)
(563) 659-9500
Entity
Organization
Contact information
Practice address
923 6TH AVE, DE WITT, IA 52742-1330
(563) 659-9500
Mailing address
923 6TH AVE, DE WITT, IA 52742-1330
(563) 659-9500
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
06566
IA
1223G0001X
General Practice Dentistry
07800
IA
1223G0001X
General Practice Dentistry
Primary
08332
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0264440
—
IA
05
—
0473173
—
IA
05
—
0911644
—
IA
Enumeration date
12/13/2006
Last updated
07/22/2008
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