Provider Demographics
NPI:1215071394
Name:NORTH IOWA ORAL SURGERY AND DENTAL IMPLANT CENTER, LLP
Entity type:Organization
Organization Name:NORTH IOWA ORAL SURGERY AND DENTAL IMPLANT CENTER, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LYELL
Authorized Official - Middle Name:R
Authorized Official - Last Name:HOGG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:641-424-1656
Mailing Address - Street 1:1530 S MONROE AVE
Mailing Address - Street 2:
Mailing Address - City:MASON CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50401
Mailing Address - Country:US
Mailing Address - Phone:641-424-1656
Mailing Address - Fax:641-424-2219
Practice Address - Street 1:1530 S MONROE AVE
Practice Address - Street 2:
Practice Address - City:MASON CITY
Practice Address - State:IA
Practice Address - Zip Code:50401
Practice Address - Country:US
Practice Address - Phone:641-424-1656
Practice Address - Fax:641-424-2219
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2018-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1223S0112X
IA07778204E00000X
IA08489204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Single Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty