Provider Demographics
NPI:1538226055
Name:MISSOURI VALLEY DENTAL GROUP LLC
Entity type:Organization
Organization Name:MISSOURI VALLEY DENTAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE SECRETARY
Authorized Official - Prefix:MS
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:KERGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-642-4136
Mailing Address - Street 1:214 E ERIE ST
Mailing Address - Street 2:
Mailing Address - City:MISSOURI VALLEY
Mailing Address - State:IA
Mailing Address - Zip Code:51555-1533
Mailing Address - Country:US
Mailing Address - Phone:712-642-4136
Mailing Address - Fax:712-642-3491
Practice Address - Street 1:214 E ERIE ST
Practice Address - Street 2:
Practice Address - City:MISSOURI VALLEY
Practice Address - State:IA
Practice Address - Zip Code:51555-1533
Practice Address - Country:US
Practice Address - Phone:712-642-4136
Practice Address - Fax:712-642-3491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty