Prairie Trails Family Dental LLC

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

PRAIRIE TRAILS FAMILY DENTAL LLC

Practice address

100 E South St
Corydon, IA 50060-1724

Phone

(641) 872-2514

Fax

(641) 872-1152

NPI assigned

Dec 18, 2012

Last updated

Nov 18, 2013By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Susan Henderson

Title

Dir. Administrative Services

Phone

(641) 872-5341

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1355788800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1384732800000",
    "number": "1336485424",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 284",
            "city": "CORYDON",
            "state": "IA",
            "postal_code": "500600284",
            "telephone_number": "641-872-2514",
            "fax_number": "641-872-1152"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 E SOUTH ST",
            "city": "CORYDON",
            "state": "IA",
            "postal_code": "500601724",
            "telephone_number": "641-872-2514",
            "fax_number": "641-872-1152"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRAIRIE TRAILS FAMILY DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-12-18",
        "last_updated": "2013-11-18",
        "status": "A",
        "authorized_official_last_name": "HENDERSON",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_title_or_position": "DIR. ADMINISTRATIVE SERVICES",
        "authorized_official_telephone_number": "641-872-5341"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• New Venture Group Home
• Eric Palmer
• Stephanie Jo Perkins Mahan, D.O.
• Caysi Porter, LMSW
• Prairie Trails Emergency Physicians
• Subha Rajan, M.D.
• James Earl Rardin
• Nicole Marie Ruble, P.A.
• Shayla Sanders, FNP-BC
• Duane P Schmaltz, RPH

• Dentist in Corydon, IA
• Providers in Corydon, IA by specialty
• Dentist in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2013; 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.