NPIMap

Organization Active NPI

Northeast Iowa Dental Professional Corporation

  • General Practice Dentistry
  • Waukon, IA
National Provider Identifier
1720173990
Registry record updated Dec 18, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
NORTHEAST IOWA DENTAL PROFESSIONAL CORPORATION
Practice address
18 1St Ave NW
Waukon, IA 52172
Phone
(563) 568-4528
Fax
(563) 568-6144
NPI assigned
Oct 4, 2006
Organization subpart
Yes
Parent organization
NORTHEAST IOWA DENTAL PROFESSIONAL CORPORATIONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 18, 2008

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

Authorized official

Name
Mrs. Judy Sue Kurth
Title
Office Manager
Phone
(563) 568-4528

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

18 1St Ave NW
Waukon, IA 52172

Mailing address

18 1St Ave NW
Waukon, IA 52172
Phone (563) 568-4528

Other names 1

  • Waukon Dental Doing business as

National Provider Directory

National Provider Directory
Part of
NE Iowa Dental Professional

Locations

18 1st Ave NW
Waukon, IA 52172
Phone (563) 539-4651

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1159920000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1229558400000",
    "number": "1720173990",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18 1ST AVE NW",
            "city": "WAUKON",
            "state": "IA",
            "postal_code": "52172",
            "telephone_number": "563-568-4528",
            "fax_number": "563-568-6144"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18 1ST AVE NW",
            "city": "WAUKON",
            "state": "IA",
            "postal_code": "52172",
            "telephone_number": "563-568-4528",
            "fax_number": "563-568-6144"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHEAST IOWA DENTAL PROFESSIONAL CORPORATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "NORTHEAST IOWA DENTAL PROFESSIONAL CORPORATION",
        "enumeration_date": "2006-10-04",
        "last_updated": "2008-12-18",
        "status": "A",
        "authorized_official_last_name": "KURTH",
        "authorized_official_first_name": "JUDY",
        "authorized_official_middle_name": "SUE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "563-568-4528",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Waukon Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Waukon, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2008; 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.