Organization
WAVELAND FAMILY DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KEVIN PAUL BAKER DDS (OWNER DENTIST)
(515) 556-4530
Entity
Organization
Contact information
Practice address
4232 UNIVERSITY AVE, DES MOINES, IA 50311-3422
(515) 277-4461
Mailing address
4232 UNIVERSITY AVE, DES MOINES, IA 50311-3422
(515) 277-4461
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
08656
IA
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
08656
LICENSE NUMBER
IA
Enumeration date
02/25/2017
Last updated
02/03/2021
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