Provider Demographics
NPI:1730355033
Name:CLINTON DENTAL SURGERY CENTER, P.C.
Entity type:Organization
Organization Name:CLINTON DENTAL SURGERY CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE V.P. AND SEC
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:M
Authorized Official - Last Name:ALT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:563-242-1565
Mailing Address - Street 1:2314 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IA
Mailing Address - Zip Code:52732-2434
Mailing Address - Country:US
Mailing Address - Phone:563-242-1565
Mailing Address - Fax:563-242-0095
Practice Address - Street 1:2314 N 2ND ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IA
Practice Address - Zip Code:52732-2434
Practice Address - Country:US
Practice Address - Phone:563-242-1565
Practice Address - Fax:563-242-0095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-06
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06659261QS0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery