Pediatric Dentristry of Coralville Inc

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

07894 Issued in IA

Legal business name

PEDIATRIC DENTRISTRY OF CORALVILLE INC

Practice address

414 10TH Ave
Ste B
Coralville, IA 52241

Phone

(319) 338-7520

Fax

(319) 351-5730

NPI assigned

Aug 2, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Polly Iben, DDS

Title

Owner

Phone

(319) 338-7520

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Pollyanne Iben, DDS

  • Pediatric Dentistry
  • Iowa City, IA
  • NPI 1164504726
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154476800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1003823113",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "414 10TH AVE",
            "address_2": "STE B",
            "city": "CORALVILLE",
            "state": "IA",
            "postal_code": "52241",
            "telephone_number": "319-338-7520",
            "fax_number": "319-351-5730"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "414 10TH AVE",
            "address_2": "STE B",
            "city": "CORALVILLE",
            "state": "IA",
            "postal_code": "52241",
            "telephone_number": "319-338-7520",
            "fax_number": "319-351-5730"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC DENTRISTRY OF CORALVILLE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-02",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "IBEN",
        "authorized_official_first_name": "POLLY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "319-338-7520",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "IA",
            "license": "07894",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2188144",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Parth Patel, TLMHC
• Prayag R Patel, DO
• Brandon James Patterson, PHARM.D.
• Ashley Pearson, MBA, RDN, LDN
• Pediatric Associates of Iowa City and Coralville
• Angelika Jongedijk Peiffer, M.D.
• Ernest Manuel Perea, M.D.
• Performance Therapies, PC
• Darin Thomas Person, LISW
• Christopher Carl Peters, M.D.

• Pediatric Dentistry in Coralville, IA
• Providers in Coralville, IA by specialty
• Pediatric Dentistry in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.