Provider Demographics
NPI:1962534446
Name:MIDWEST ORAL & FACIAL SURGERY, P.C.
Entity type:Organization
Organization Name:MIDWEST ORAL & FACIAL SURGERY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:LEMON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MD
Authorized Official - Phone:515-221-0807
Mailing Address - Street 1:1225 JORDAN CREEK PKWY
Mailing Address - Street 2:STE. 120
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-2345
Mailing Address - Country:US
Mailing Address - Phone:515-221-0807
Mailing Address - Fax:515-221-0816
Practice Address - Street 1:1225 JORDAN CREEK PKWY
Practice Address - Street 2:STE. 120
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-2345
Practice Address - Country:US
Practice Address - Phone:515-221-0807
Practice Address - Fax:515-221-0816
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-11
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA80321223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty