Organization
FORT DODGE ORAL AND MAXILLOFACIAL SURGERY LLP
Active
Other names
Fort Dodge Oral and Maxillofacial Surgery PC
Organization subpart
No
Provider details
NPI number
Authorized official
ELIZABETH SCHRAUTH (OFFICE MANAGER)
(515) 576-8727
Entity
Organization
Contact information
Practice address
804 KENYON RD, STE 120, FORT DODGE, IA 50501-5742
(515) 576-8727
(515) 576-7076
Mailing address
804 KENYON RD STE 120, FORT DODGE, IA 50501-5746
(515) 576-8727
(515) 576-7076
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0438101
—
IA
05
—
1095471
—
IA
05
—
1165050
—
IA
Enumeration date
03/16/2007
Last updated
12/29/2017
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