Organization
WAYNE COUNTY HOSPITAL
Active
Other names
Prairie Trails Family Dental
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN HENDERSON (CLINIC ADMINISTRATOR)
(641) 872-2260
Entity
Organization
Contact information
Practice address
100 E SOUTH ST, CORYDON, IA 50060-1724
(641) 872-2514
Mailing address
PO BOX 284, CORYDON, IA 50060-0284
(641) 872-2514
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
08461
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
70326
BLUE CROSS BLUE SHIELD FEDERAL EMPLOYEE PROGRAM
IA
Enumeration date
06/24/2008
Last updated
06/24/2008
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