Provider Demographics
NPI:1245506138
Name:DAVID G LLEWELYN, DDS PC
Entity type:Organization
Organization Name:DAVID G LLEWELYN, DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER/RDA
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:JO
Authorized Official - Last Name:VANCE
Authorized Official - Suffix:
Authorized Official - Credentials:RDA
Authorized Official - Phone:515-223-1274
Mailing Address - Street 1:701 13TH ST
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50265-3404
Mailing Address - Country:US
Mailing Address - Phone:515-223-1274
Mailing Address - Fax:515-223-9421
Practice Address - Street 1:701 13TH ST
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50265-3404
Practice Address - Country:US
Practice Address - Phone:515-223-1274
Practice Address - Fax:515-223-9421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-26
Last Update Date:2012-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA19Other19 GROUP