Provider Demographics
NPI:1316943723
Name:IHLEFELD, GARY BRUNO (DDS)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:BRUNO
Last Name:IHLEFELD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1616 YOUNG AVE
Mailing Address - Street 2:
Mailing Address - City:MUSCATINE
Mailing Address - State:IA
Mailing Address - Zip Code:52761-3435
Mailing Address - Country:US
Mailing Address - Phone:563-263-0017
Mailing Address - Fax:563-263-0831
Practice Address - Street 1:1616 YOUNG AVE
Practice Address - Street 2:
Practice Address - City:MUSCATINE
Practice Address - State:IA
Practice Address - Zip Code:52761-3435
Practice Address - Country:US
Practice Address - Phone:563-263-0017
Practice Address - Fax:563-263-0831
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA63891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice