Provider Demographics
NPI:1124153952
Name:EXPRESSIONS DENTAL, L.L.C.
Entity type:Organization
Organization Name:EXPRESSIONS DENTAL, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:CLARY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:515-232-0558
Mailing Address - Street 1:703 8TH ST
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:IA
Mailing Address - Zip Code:50036-2727
Mailing Address - Country:US
Mailing Address - Phone:515-432-5826
Mailing Address - Fax:515-432-1721
Practice Address - Street 1:703 8TH ST
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:IA
Practice Address - Zip Code:50036-2727
Practice Address - Country:US
Practice Address - Phone:515-432-5826
Practice Address - Fax:515-432-1721
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2009-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA063211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty