Provider Demographics
NPI:1962069898
Name:BUFFALO PRAIRIE DENTAL OF KEOKUK, PLLC
Entity type:Organization
Organization Name:BUFFALO PRAIRIE DENTAL OF KEOKUK, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DAUNN
Authorized Official - Middle Name:
Authorized Official - Last Name:STURHAHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-257-0386
Mailing Address - Street 1:3327 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:KEOKUK
Mailing Address - State:IA
Mailing Address - Zip Code:52632-2225
Mailing Address - Country:US
Mailing Address - Phone:319-524-8811
Mailing Address - Fax:319-524-9785
Practice Address - Street 1:3327 MAIN ST
Practice Address - Street 2:
Practice Address - City:KEOKUK
Practice Address - State:IA
Practice Address - Zip Code:52632-2225
Practice Address - Country:US
Practice Address - Phone:319-524-8811
Practice Address - Fax:319-524-9785
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-27
Last Update Date:2019-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty