Prairie Trails Family Dental LLC

NPI #1336485424 in Corydon, Iowa

Provider Information

NPI Number: 1336485424
Entity Type: Organization
Organization Name: Prairie Trails Family Dental LLC
Primary Specialty: Dentist
Enumeration Date: Dec 18, 2012
Last Updated: Nov 18, 2013

Practice Location

Address: 100 E SOUTH ST
City: Corydon
State: Iowa
ZIP Code: 50060-1724
Phone: (641) 872-2514

Authorized Official

Name: SUSAN HENDERSON
Title: DIR. ADMINISTRATIVE SERVICES
Phone: (641) 872-5341

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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