Organization
IOWA ORAL AND MAXILLOFACIAL SURGEONS, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DIANA GAIL WEIRICH (INSURANCE COORDINATOR)
(515) 327-1647
Entity
Organization
Contact information
Practice address
1469 29TH ST, WEST DES MOINES, IA 50266-1302
(515) 223-6529
(515) 223-5448
Mailing address
1469 29TH ST, WEST DES MOINES, IA 50266-1302
(515) 223-6529
(515) 223-5448
Taxonomy
Speciality
Code
Description
License number
State
1223P0106X
Oral and Maxillofacial Pathology Dentistry
Primary
06447
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
22178
MEDICARE PTAN
IA
Enumeration date
01/24/2006
Last updated
05/30/2008
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