Provider Demographics
NPI:1386801108
Name:STEFFANY L MOHAN DDS PC
Entity type:Organization
Organization Name:STEFFANY L MOHAN DDS PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST/BUSINESS OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEFFANY
Authorized Official - Middle Name:
Authorized Official - Last Name:MOHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:515-224-5999
Mailing Address - Street 1:1089 JORDAN CREEK PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-5829
Mailing Address - Country:US
Mailing Address - Phone:515-224-5999
Mailing Address - Fax:515-224-5966
Practice Address - Street 1:1089 JORDAN CREEK PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-5829
Practice Address - Country:US
Practice Address - Phone:515-224-5999
Practice Address - Fax:515-224-5966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-20
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA78351223G0001X, 261QD0000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0197160Medicaid