Provider Demographics
NPI:1902061559
Name:DES MOINES AREA COMMUNITY COLLEGE DENTAL HYGIENE CLINIC
Entity Type:Organization
Organization Name:DES MOINES AREA COMMUNITY COLLEGE DENTAL HYGIENE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:E
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-964-6371
Mailing Address - Street 1:2006 S ANKENY BLVD
Mailing Address - Street 2:BUILDING 9 - ROOM 2
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50023-8995
Mailing Address - Country:US
Mailing Address - Phone:515-964-6280
Mailing Address - Fax:515-964-6602
Practice Address - Street 1:2006 S ANKENY BLVD
Practice Address - Street 2:BUILDING 9 - ROOM 2
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50023-8995
Practice Address - Country:US
Practice Address - Phone:515-964-6280
Practice Address - Fax:515-964-6602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-23
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA05044251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)