Organization
SOUTHWEST ORTHODONTIC ASSOCIATES, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WENDELL R. STUNTZ D.D.S. (OWNER)
(712) 323-7589
Entity
Organization
Contact information
Practice address
40 NORTHCREST DR STE 2, COUNCIL BLUFFS, IA 51503-1698
(712) 323-7589
(712) 323-8255
Mailing address
40 NORTHCREST DR STE 2, COUNCIL BLUFFS, IA 51503-1698
(712) 323-7589
(712) 323-8255
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
06149
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1508943986
—
IA
05
—
1689868945
—
IA
Enumeration date
05/16/2008
Last updated
05/16/2008
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