NPIMap

Organization Active NPI

Southwest Iowa Dental Associates Inc

Doing business as Southwest Iowa Dental Associates

  • Dentist
  • Shenandoah, IA
National Provider Identifier
1013215805
Registry record updated Jan 29, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
5587 Issued in IA
Legal business name
SOUTHWEST IOWA DENTAL ASSOCIATES INC
Doing business as
Southwest Iowa Dental Associates
Practice address
1213 W Nishna Rd
Shenandoah, IA 51601-2115
Phone
(712) 246-2180
Fax
(712) 246-1683
NPI assigned
Mar 3, 2011
Last updated
Jan 29, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 29, 2020

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

Authorized official

Name
Jillian TravisNPI 1821392457
Title
Owner
Phone
(712) 246-2180

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 5587 IA Primary

Addresses

Primary practice location

1213 W Nishna Rd
Shenandoah, IA 51601-2115

Mailing address

1213 W Nishna Rd
Shenandoah, IA 51601-2115
Phone (712) 246-2180

Other names 1

  • Southwest Iowa Dental Associates Doing business as

National Provider Directory

National Provider Directory

Locations

1204 W Sheridan Ave
Shenandoah, IA 51601

1204 W Sheridan Ave
#A
Shenandoah, IA 51601
Phone (712) 246-2180

1213 W Nishna Rd
Shenandoah, IA 51601
Phone (712) 246-2180

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1299110400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1580256000000",
    "number": "1013215805",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1213 W NISHNA RD",
            "city": "SHENANDOAH",
            "state": "IA",
            "postal_code": "516012115",
            "telephone_number": "712-246-2180",
            "fax_number": "712-246-1683"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1213 W NISHNA RD",
            "city": "SHENANDOAH",
            "state": "IA",
            "postal_code": "516012115",
            "telephone_number": "712-246-2180",
            "fax_number": "712-246-1683"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHWEST IOWA DENTAL ASSOCIATES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-03-03",
        "last_updated": "2020-01-29",
        "certification_date": "2020-01-29",
        "status": "A",
        "authorized_official_last_name": "TRAVIS",
        "authorized_official_first_name": "JILLIAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "712-246-2180"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IA",
            "license": "5587",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southwest Iowa Dental Associates",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Southwest Iowa Dental Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Shenandoah, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 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.