IOWA PEDIATRIC DENTAL CENTER (NPI# 1639595952) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1639595952 |
| Entity Type | Organization |
| Organization Name | IOWA PEDIATRIC DENTAL CENTER |
| Practice Address |
501 12th Ave Suite 202 Coralville IA 52241-1774 |
| Practice Telephone | 3193515439 |
| Practice Fax Number | 3193540491 |
| Mailing Telephone | 3193515439 |
| Mailing Fax Number | 3193540491 |
| Enumeration Date | 2014-03-11 |
| Last Update Date | 2014-03-11 |
| Authorized Official Name | DR. DONALD CRAIG PETERSON JR. (DOCTOR/OWNER) |
| Authorized Official Telephone | 3193515439 |
| Authorized Official Credential | D.D.S. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223P0221X |
Dentist Specialization: Pediatric Dentistry |
08193 | IA | Dental Providers |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Iowa Business Entities | IOWA PEDIATRIC DENTAL CENTER II, LLC | 5350 Kirkwood Blvd, Suite 700, Cedar Rapids, IA 52404 |
| Iowa Business Entities | IOWA PEDIATRIC DENTAL CENTER, L.L.C. | 501 12th Ave Ste 202, Coralville, IA 52241 |
| Street Address |
501 12TH AVE SUITE 202 |
| City | CORALVILLE |
| State | IA |
| Zip Code | 52241-1774 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992775126 | Jill H. Scholz | Podiatrist | 501 12th Ave, Suite 203, Coralville, IA 52241-1774 | 2006-01-23 |
| 1407334238 | Lily French | Social Worker | 501 12th Ave, Coralville, IA 52241-1774 | 2018-08-02 |
| 1487002762 | Alice Claussen | Acupuncturist | 501 12th Ave, Suite 102, Coralville, IA 52241-1774 | 2016-05-27 |
| 1083947667 | Eastern Iowa Periodontics, PC | Dentist | 501 12th Ave, Suite 202, Coralville, IA 52241-1774 | 2009-09-14 |
| 1649403296 | Susan C Puhl | Dermatology | 501 12th Ave, Suite 101, Coralville, IA 52241-1774 | 2009-08-31 |
| 1265660815 | Christina Carol Finken | Podiatrist | 501 12th Ave, Suite 203, Coralville, IA 52241-1774 | 2009-06-22 |
| 1497932842 | Jill H Scholz | Clinic/Center | 501 12th Ave, Suite 203, Coralville, IA 52241-1774 | 2008-01-29 |
| 1982883336 | Claudette J Heddens | Nurse Practitioner | 501 12th Ave, Suite 102, Coralville, IA 52241-1774 | 2007-11-01 |
| 1952500365 | Adrienne S Gunstream | Dentist | 501 12th Ave, Suite 202, Coralville, IA 52241-1774 | 2007-07-16 |
| 1912103979 | Dermatology Associates LLP | Dermatology | 501 12th Ave, Suite 101, Coralville, IA 52241-1774 | 2007-06-26 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780281915 | Impact Physician Group Iowa LLC | Internal Medicine | 2801 Heartland Dr, Coralville, IA 52241 | 2020-10-01 |
| 1114550886 | Encompass Health Rehabilitation Hospital of Iowa City, LLC | Rehabilitation Hospital | 2450 Coral Court, Coralville, IA 52241 | 2020-02-20 |
| 1215575394 | Eastern Iowa Rehabilitation Hospital, LLC | Rehabilitation Hospital | 2801 Heartland Drive, Coralville, IA 52241 | 2019-12-19 |
| 1851938690 | Matthew Easley | Speech-Language Pathologist | 2854 Coral Court, Ste 1, On With Life Outpatient Neuro Rehabilitation, Coralville, IA 52241 | 2019-11-27 |
| 1245892629 | On With Life, Inc | Clinic/Center | 2854 Coral Court, Suite 1, Coralville, IA 52241 | 2019-07-05 |
| 1376024869 | Hy Vee Inc | Pharmacy | 3285 Crosspark Road, Coralville, IA 52241 | 2018-08-23 |
| 1861996191 | Roggy Vision Center, Pllc | Optometrist | 708 5th St Ste 1, Coralville, IA 52241 | 2018-03-21 |
| 1013446467 | Monica Basile | Midwife | 501 12th Ave, St 102, Coralville, IA 52241 | 2017-06-08 |
| 1568893121 | Mohamed Karim | Chiropractor | 1801 Brown Deer Trail, Coralville, IA 52241 | 2013-12-09 |
| 1689011405 | Nicole Ann Wagaman | Family Medicine | 2801 Heartland Dr., Coralville, IA 52241 | 2013-06-03 |
| Find all providers in zip 52241 | ||||
| Taxonomy Code | 1223P0221X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Pediatric Dentistry |
| An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528681897 | The Children's Dental Center, Pllc | Dentist | 2761 Oakdale Blvd Ste 4, Coralville, IA 52241-9754 | 2020-05-21 |
| 1750485447 | Katherine Johanna Konz | Dentist | 2122 Abbie Ct, Coralville, IA 52241-9713 | 2006-09-12 |
| 1003823113 | Pediatric Dentristry of Coralville Inc | Dentist | 414 10th Ave, Ste B, Coralville, IA 52241 | 2006-08-02 |
| 1417030057 | Donald C Peterson Jr. | Dentist | 501 12th Ave, Suite 202, Coralville, IA 52241 | 2006-10-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659934701 | Grimes Pediatric Dentistry P C | Dentist | 1551 Se 3rd St Ste 100, Grimes, IA 50111-8861 | 2019-04-15 |
| 1215316633 | Kaitlin Joy Hoogeveen | Dentist | 164 S Main Ave, Sioux Center, IA 51250-1536 | 2015-05-19 |
| 1760801062 | Diana Pelzer | Dentist | 1250 Se University Ave, Waukee, IA 50263-8831 | 2014-04-15 |
| 1245656800 | Iowa Pediatric Dental Center II LLC | Dentist | 5350 Kirkwood Blvd Sw, Suite 700, Cedar Rapids, IA 52404-5233 | 2014-03-06 |
| 1528483716 | Peter Joseph Stanley | Dentist | 201 Dental Science Bldg S., Iowa City, IA 52242-1001 | 2014-02-24 |
| 1821433160 | Nicholas Wade Barnard | Dentist | 4090 Westown Pkwy Ste B1, West Des Moines, IA 50266 | 2013-04-30 |
| 1962745471 | Samuel Christensen | Dentist | 2575 N Ankeny Blvd Ste 205, Ankeny, IA 50023-4710 | 2013-04-03 |
| 1477818326 | Julie Ann Smith | Dentist | 800 E 1st St Ste 2800, Ankeny, IA 50021-2077 | 2012-07-06 |
| 1043507890 | Molly Bremen | Dentist | 7600 Fleur Dr, Des Moines, IA 50321-3111 | 2011-06-30 |
| 1497067698 | Sarah Elizabeth Swenson | Dentist | 1962 1st Avenue Ne, Cedar Rapids, IA 52402-5334 | 2010-07-06 |
| Find all providers with the same taxonomy | ||||
| City | CORALVILLE |
| Zip Code | 52241 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.