Individual
VERUTZKA N SOZA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
100 W WALNUT AVE STE 142, DALTON, GA 30720-8440
(706) 529-8427
Mailing address
125 SCOTT ST, DAVENPORT, IA 52801-1130
(563) 336-3221
(563) 336-3229
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
DN013956
GA
1223G0001X
General Practice Dentistry
Primary
08503
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0080200
—
IA
01
—
1932193224
MEDICAID GROUP NPI #
IA
Enumeration date
08/01/2007
Last updated
04/20/2023
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