Organization
STATE UNIVERSITY OF IOWA
Active
Parent organization
STATE UNIVERSITY OF IOWA
Other names
Hospital Dentistry Institute
Organization subpart
Yes
Provider details
NPI number
Legal business name
STATE UNIVERSITY OF IOWA
Authorized official
PAULINA JANCZUK BBA MPH (ASSISTANT DEAN FINANCIAL AFFAIRS)
(319) 467-0735
Entity
Organization
Contact information
Practice address
200 HAWKINS DRIVE, 51300 POMERANTZ FAMILY PAVILION, IOWA CITY, IA 52242-1049
(319) 356-2743
(319) 353-6923
Mailing address
200 HAWKINS DRIVE, 51300 POMERANTZ FAMILY PAVILION, IOWA CITY, IA 52242-1049
(319) 356-2743
(319) 353-6923
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
1223P0700X
Prosthodontics
—
—
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0177832
—
IA
01
—
33538
WELLMARK MAXILLOFACIAL SP
IA
Enumeration date
01/06/2006
Last updated
02/28/2025
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