David M Dettman, D.D.S.
Individual provider Active NPI General Practice Dentistry · Sidney, IA
NPI 1801964739 · NPPES record last updated Jul 9, 2007
Key facts
- NPI
- 1801964739
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 6865 (IA)
- Practice address
- 804 Illinois Street
Sidney, IA 51652 - Phone
- (712) 374-2029
- NPI assigned
- Nov 30, 2006
- 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 |
|---|---|---|---|
| 6865 | IA | MD | General Practice Dentistry |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 6865 | IA | Yes |
| General Practice Dentistry | 1223G0001X | 5136 | NE |
Addresses
Primary practice location
804 Illinois Street
Sidney, IA 51652
Mailing address
107 N 10TH St
Nebraska City, NE 68410-2329
Phone (402) 873-5040
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0091421 | Medicaid | IA | |
| 470681388001 | Medicaid | NE |
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All providers in Sidney, IA · General Practice Dentistry in Iowa
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 9, 2007. 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.