Missouri Valley Dental Group, LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

07421 Issued in IA

Legal business name

MISSOURI VALLEY DENTAL GROUP, LLC

Practice address

214 E Erie St
Missouri Valley, IA 51555-1533

Phone

(712) 642-4136

Fax

(712) 642-3664

NPI assigned

Aug 5, 2007

Organization subpart

No

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

Authorized official

Name

Jean Kerger

Title

Corporation Manager

Phone

(712) 642-4136

Specialties & licenses 1

Addresses

Other identifiers 4

Locations

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

{
    "created_epoch": "1186272000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1186272000000",
    "number": "1073704359",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "214 E ERIE ST",
            "city": "MISSOURI VALLEY",
            "state": "IA",
            "postal_code": "515551533",
            "telephone_number": "712-642-4136",
            "fax_number": "712-642-3664"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "214 E ERIE ST",
            "city": "MISSOURI VALLEY",
            "state": "IA",
            "postal_code": "515551533",
            "telephone_number": "712-642-4136",
            "fax_number": "712-642-3664"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MISSOURI VALLEY DENTAL GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-05",
        "last_updated": "2007-08-05",
        "status": "A",
        "authorized_official_last_name": "KERGER",
        "authorized_official_first_name": "JEAN",
        "authorized_official_title_or_position": "CORPORATION MANAGER",
        "authorized_official_telephone_number": "712-642-4136"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "IA",
            "license": "07421",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0492033",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5264622",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2152637",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6060053",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Zimmie Elaine Marks
• Sara M McIntosh, ARNP
• David A Minnick, MD
• Missouri Valley Community School District
• Missouri Valley Dental Group LLC
• Missouri Valley Volunteer Fire Department
• Leigh Moore
• Allison Marie Pagan, MD
• Gary Charles Paul, RPH
• Susan M Peschel, NP

• All providers in Missouri Valley, IA
• General Practice Dentistry in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2007; 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.