Provider Demographics
NPI:1588406276
Name:KDB DENTAL PLLC
Entity type:Organization
Organization Name:KDB DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:ABBY
Authorized Official - Middle Name:LAYNE
Authorized Official - Last Name:MARINER
Authorized Official - Suffix:
Authorized Official - Credentials:RDA
Authorized Official - Phone:319-573-1554
Mailing Address - Street 1:2800 4TH ST SW STE 1
Mailing Address - Street 2:
Mailing Address - City:MASON CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50401-1596
Mailing Address - Country:US
Mailing Address - Phone:641-423-0064
Mailing Address - Fax:641-421-7544
Practice Address - Street 1:2800 4TH ST SW STE 1
Practice Address - Street 2:
Practice Address - City:MASON CITY
Practice Address - State:IA
Practice Address - Zip Code:50401-1596
Practice Address - Country:US
Practice Address - Phone:641-423-0064
Practice Address - Fax:641-421-7544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-12
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No292200000XLaboratoriesDental Laboratory