Provider Demographics
NPI:1861716599
Name:IOWA DENTAL CLINIC, PC
Entity type:Organization
Organization Name:IOWA DENTAL CLINIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FARIHA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAIG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:515-314-9169
Mailing Address - Street 1:PO BOX 22112
Mailing Address - Street 2:
Mailing Address - City:CLIVE
Mailing Address - State:IA
Mailing Address - Zip Code:50325-9402
Mailing Address - Country:US
Mailing Address - Phone:515-314-9169
Mailing Address - Fax:
Practice Address - Street 1:5601 HICKMAN RD
Practice Address - Street 2:SUITE-5
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50310-1163
Practice Address - Country:US
Practice Address - Phone:515-314-9169
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-24
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA08616122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty