Organization
DIAMOND TRAIL DENTAL PC
Active
Other names
Diamond Trail Dental
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ERIC CHAD DEBOEF D.D.S. (PRESIDENT)
(641) 673-3008
Entity
Organization
Contact information
Practice address
301 S. 4TH ST., MONTEZUMA, IA 50171-1031
(641) 623-5100
Mailing address
107 HIGH AVE E, OSKALOOSA, IA 52577-2831
(641) 673-3008
(641) 672-8807
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
02/04/2013
Last updated
02/04/2013
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