Organization
FORT DES MOINES DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK LAZAR (OWNER)
(515) 287-5400
Entity
Organization
Contact information
Practice address
6100 SW 9TH ST, DES MOINES, IA 50315-5013
(515) 287-5400
(515) 287-5401
Mailing address
6100 SW 9TH ST, DES MOINES, IA 50315-5013
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
6030
IA
Other
Enumeration date
06/04/2012
Last updated
06/04/2012
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