Provider Demographics
NPI:1396814810
Name:IRWIN, JEAN E (DDS)
Entity type:Individual
Prefix:DR
First Name:JEAN
Middle Name:E
Last Name:IRWIN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 1ST ST. NW
Mailing Address - Street 2:BOX 278
Mailing Address - City:PRIMGHAR
Mailing Address - State:IA
Mailing Address - Zip Code:51245-0278
Mailing Address - Country:US
Mailing Address - Phone:712-957-2460
Mailing Address - Fax:712-957-1013
Practice Address - Street 1:135 1ST ST. NW
Practice Address - Street 2:BOX 278
Practice Address - City:PRIMGHAR
Practice Address - State:IA
Practice Address - Zip Code:51245-0278
Practice Address - Country:US
Practice Address - Phone:712-957-2460
Practice Address - Fax:712-957-1013
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA6326122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist