Organization
PRAIRIE TRAILS FAMILY DENTAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN HENDERSON (DIR. ADMINISTRATIVE SERVICES)
(641) 872-5341
Entity
Organization
Contact information
Practice address
100 E SOUTH ST, CORYDON, IA 50060-1724
(641) 872-2514
(641) 872-1152
Mailing address
PO BOX 284, CORYDON, IA 50060-0284
(641) 872-2514
(641) 872-1152
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Enumeration date
12/18/2012
Last updated
11/18/2013
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