Provider Demographics
NPI:1427168749
Name:VERBIK, DAVID JOSEPH (DDS PHD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:JOSEPH
Last Name:VERBIK
Suffix:
Gender:M
Credentials:DDS PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 122
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51449
Mailing Address - Country:US
Mailing Address - Phone:712-464-3124
Mailing Address - Fax:712-464-7479
Practice Address - Street 1:1331 WEST MAIN STREET
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:IA
Practice Address - Zip Code:51449
Practice Address - Country:US
Practice Address - Phone:712-464-3124
Practice Address - Fax:712-464-7479
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA081631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0265447Medicaid
NE10025042400Medicaid
IA55729OtherWELLMARK