Western Iowa Dental Group,PC

Primary specialty

DentistTaxonomy code 122300000X

License

07421 Issued in IA

Legal business name

WESTERN IOWA DENTAL GROUP,PC

Practice address

114 1/2 S 6TH St
Council Bluffs, IA 51501-4234

Phone

(712) 325-1544

Fax

(712) 325-0420

NPI assigned

Mar 6, 2014

Organization subpart

Yes

Parent organization

WESTERN IOWA DENTAL GROUP, PCAs reported in NPPES

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

Authorized official

Name

Mrs. Betty Kerger

Title

Office Manager

Phone

(712) 325-1544

Specialties & licenses 1

Addresses

Other names 1

• Bayliss Park Dental Group Doing business as

Tax ID family

Western Iowa Dental Grouppc2 organizations share this tax ID, including this one

Part of

Western Iowa Dental Grouppc

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Western Iowa Dental Group,PC

  • Dentist
  • Omaha, NE
  • NPI 1447666151
  NPD tax ID

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Western Iowa Dental Group, LLC

  • General Practice Dentistry
  • Council Bluffs, IA
  • NPI 1841574886
  NPPES parent name

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

{
    "created_epoch": "1394064000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1394064000000",
    "number": "1073939799",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1509 AVENUE G",
            "city": "COUNCIL BLUFFS",
            "state": "IA",
            "postal_code": "515012516",
            "telephone_number": "712-325-1544",
            "fax_number": "712-325-0420"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "114 1/2 S 6TH ST",
            "city": "COUNCIL BLUFFS",
            "state": "IA",
            "postal_code": "515014234",
            "telephone_number": "712-325-1544",
            "fax_number": "712-325-0420"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WESTERN IOWA DENTAL GROUP,PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WESTERN IOWA DENTAL GROUP, PC",
        "enumeration_date": "2014-03-06",
        "last_updated": "2014-03-06",
        "status": "A",
        "authorized_official_last_name": "KERGER",
        "authorized_official_first_name": "BETTY",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "712-325-1544",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "IA",
            "license": "07421",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bayliss Park Dental Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• West Broadway Clinic, P.C.
• West Broadway Clinic, P.C.
• West Broadway Clinic, PC
• Gina West-Hendrickson
• Western Iowa Dental Group, LLC
• Sheila Mary Wettengel, RPH
• William L Wettengel, RPH
• James Whalen, M.D.
• Angela Wheeler
• Andrea Celeste White, ARNP

• Dentist in Council Bluffs, IA
• Providers in Council Bluffs, IA by specialty
• Dentist in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2014; 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.