Organization
DENTISTRY ON 5TH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LEANN KIM SOU (OFFICE MANAGER)
(515) 243-4616
Entity
Organization
Contact information
Practice address
505 5TH AVE, SUITE 939, DES MOINES, IA 50309-2324
(515) 243-4616
Mailing address
505 5TH AVE, SUITE 939, DES MOINES, IA 50309-2324
(515) 243-4616
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
08454
IA
1223G0001X
General Practice Dentistry
08950
IA
Other
Enumeration date
04/04/2014
Last updated
04/04/2014
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