Individual
DR. NICOL LISA GINDORFF
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
525 W CHERRY ST, NORTH LIBERTY, IA 52317-9797
(319) 621-1507
Mailing address
525 W CHERRY ST, NORTH LIBERTY, IA 52317-9797
(319) 621-1507
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
08884
IA
1223G0001X
General Practice Dentistry
D12134
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
163445300
—
MN
Enumeration date
12/14/2006
Last updated
12/30/2019
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