Organization
MISSOURI VALLEY DENTAL GROUP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. JEAN ANN KERGER (CORPORATE MANAGER)
(712) 647-2450
Entity
Organization
Contact information
Practice address
73 7TH ST, WOODBINE, IA 51579-1147
(712) 647-2450
(712) 647-2470
Mailing address
73 7TH ST, WOODBINE, IA 51579-1147
(712) 647-2450
(712) 647-2470
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1496026
—
IA
05
—
4264622
—
IA
Enumeration date
01/03/2007
Last updated
07/31/2007
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