NPIMap

Organization Active NPI

Edp of Iowa PC

  • Dental Clinic/Center
  • Marshalltown, IA
National Provider Identifier
1275049314
Registry record updated Sep 20, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
Legal business name
EDP OF IOWA PC
Practice address
110 N 1St St
Marshalltown, IA 50158-5804
Phone
(641) 752-3337
NPI assigned
Dec 27, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 20, 2021

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

Authorized official

Name
Melissa Garibay
Title
Credentialing Manager
Phone
(312) 736-8963

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X Primary

Addresses

Primary practice location

110 N 1St St
Marshalltown, IA 50158-5804

Mailing address

141 W Jackson Blvd Ste 210
Chicago, IL 60604-3048
Phone (312) 937-3619

Other practice location 1

4220 Sergeant Rd Ste 100
Sioux City, IA 51106-4648
Phone (712) 274-2228

Other practice location 2

141 W Jackson Blvd
Chicago, IL 60604-2992
Phone (312) 800-1275

National Provider Directory

National Provider Directory
Tax ID family
Edp of Iowa PC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

4220 Sergeant Rd
Ste 100
Sioux City, IA 51106
Phone (712) 274-2228

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

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": "1514332800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1632096000000",
    "number": "1275049314",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "141 W JACKSON BLVD STE 210",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606043048",
            "telephone_number": "312-937-3619"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 N 1ST ST",
            "city": "MARSHALLTOWN",
            "state": "IA",
            "postal_code": "501585804",
            "telephone_number": "641-752-3337"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4220 Sergeant Rd Ste 100",
            "address_purpose": "LOCATION",
            "city": "Sioux City",
            "state": "IA",
            "postal_code": "511064648",
            "country_code": "US",
            "telephone_number": "712-274-2228",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "141 W Jackson Blvd",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606042992",
            "country_code": "US",
            "telephone_number": "312-800-1275",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "EDP OF IOWA PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-12-27",
        "last_updated": "2021-09-20",
        "certification_date": "2021-09-20",
        "status": "A",
        "authorized_official_last_name": "GARIBAY",
        "authorized_official_first_name": "MELISSA",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "312-736-8963"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Marshalltown, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2021; 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.