Jerry W. Kaalberg, DDS
Individual provider Active NPI Periodontics · Cedar Rapids, IA
NPI 1295902161 · NPPES record last updated May 10, 2008
Key facts
- NPI
- 1295902161
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Periodontics 1223P0300X
- License
- 5773 (IA)
- Practice address
- 2727 1St Ave SE
Cedar Rapids, IA 52402-4844 - Phone
- (319) 364-7111
- NPI assigned
- May 10, 2008
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5773 | IA | MD | Periodontist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Periodontics | 1223P0300X | 5773 | IA | Yes |
Addresses
Primary practice location
2727 1St Ave SE
Cedar Rapids, IA 52402-4844
Mailing address
2727 1St Ave SE
Cedar Rapids, IA 52402-4844
Phone (319) 364-7111
Other providers in Cedar Rapids, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 10, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.