Provider Demographics
NPI:1194050286
Name:CEDAR VALLEY PEDIATRIC DENTISTRY, PC
Entity type:Organization
Organization Name:CEDAR VALLEY PEDIATRIC DENTISTRY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KELLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:RUEHS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:319-277-4600
Mailing Address - Street 1:1301 W 1ST ST
Mailing Address - Street 2:
Mailing Address - City:CEDAR FALLS
Mailing Address - State:IA
Mailing Address - Zip Code:50613-2113
Mailing Address - Country:US
Mailing Address - Phone:319-277-4600
Mailing Address - Fax:319-266-5270
Practice Address - Street 1:1301 W 1ST ST
Practice Address - Street 2:
Practice Address - City:CEDAR FALLS
Practice Address - State:IA
Practice Address - Zip Code:50613-2113
Practice Address - Country:US
Practice Address - Phone:319-277-4600
Practice Address - Fax:319-266-5270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-07
Last Update Date:2009-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA079381223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty