Organization
EASTERN IOWA ORAL AND MAXILLOFACIAL SURGERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SUZANNE J. STEWART (OFFICE MANAGER)
(319) 366-8277
Entity
Organization
Contact information
Practice address
4150 EDGEWOOD ROAD NE, SUITE 100, CEDAR RAPIDS, IA 52402-0609
(319) 366-8277
(319) 366-7091
Mailing address
4150 EDGEWOOD ROAD NE, SUITE 100, CEDAR RAPIDS, IA 52402-0609
(319) 366-8277
(319) 366-7091
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
08986
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
08986
BENJAMIN L. FULLER LICENSE NUMBER
IA
01
—
09173
JAROM E. MAURER LICENSE NUMBER
IA
01
—
1265727150
JAROM E. MAURER NPI
IA
01
—
1689802910
BENJAMIN L. FULLER NPI
IA
Enumeration date
05/20/2008
Last updated
12/28/2021
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