NPIMap

Organization Active NPI

Children's Dentistry of Council Bluffs, P.C.

  • Pediatric Dentistry
  • Council Bluffs, IA
National Provider Identifier
1033232186
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
8243 Issued in IA
Legal business name
CHILDREN'S DENTISTRY OF COUNCIL BLUFFS, P.C.
Practice address
40 Northcrest Dr
Council Bluffs, IA 51503-1622
Phone
(712) 328-9605
Fax
(712) 328-9608
NPI assigned
Apr 6, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Joseph Anthony Quattrocchi Jr., D.D.S.NPI 1134203516
Title
Owner
Phone
(712) 328-9605

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
Pediatric Dentistry 1223P0221X 8243 IA Primary

Addresses

Primary practice location

40 Northcrest Dr
Council Bluffs, IA 51503-1622

Mailing address

40 Northcrest Dr
Council Bluffs, IA 51503-1622
Phone (712) 328-9605

Other identifiers 2

IdentifierTypeStateIssuer
0463612MedicaidIA
8243OtherIADENTAL LICENSE NUMBER

National Provider Directory

National Provider Directory

Locations

40 Northcrest Dr
Council Bluffs, IA 51503
Phone (712) 328-9605

Practitioners & affiliated clinicians

Practitioners 1

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": "1175817600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1033232186",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "40 NORTHCREST DR",
            "city": "COUNCIL BLUFFS",
            "state": "IA",
            "postal_code": "515031622",
            "telephone_number": "712-328-9605",
            "fax_number": "712-328-9608"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "40 NORTHCREST DR",
            "city": "COUNCIL BLUFFS",
            "state": "IA",
            "postal_code": "515031622",
            "telephone_number": "712-328-9605",
            "fax_number": "712-328-9608"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHILDREN'S DENTISTRY OF COUNCIL BLUFFS, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-06",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "QUATTROCCHI",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_middle_name": "ANTHONY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "712-328-9605",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "IA",
            "license": "8243",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0463612",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTAL LICENSE NUMBER",
            "identifier": "8243",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Council Bluffs, IA

Sources for this page

  • 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.