Basic Information
| Provider Information | |||||||||
| NPI: | 1336328509 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | AMES ORAL SURGEONS, P.C. | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | MARSHALLTOWN ORAL SURGEONS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1212 DUFF AVE | ||||||||
| Address2: | |||||||||
| City: | AMES | ||||||||
| State: | IA | ||||||||
| PostalCode: | 500105467 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5152326830 | ||||||||
| FaxNumber: | 5152323296 | ||||||||
| Practice Location | |||||||||
| Address1: | 1212 DUFF AVE | ||||||||
| Address2: | |||||||||
| City: | AMES | ||||||||
| State: | IA | ||||||||
| PostalCode: | 500105467 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5152326830 | ||||||||
| FaxNumber: | 5152323296 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/24/2007 | ||||||||
| LastUpdateDate: | 10/24/2007 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | RUDMAN | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 5152326830 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | D.D.S., M.S. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QS0112X | 5764 | IA | N | Ambulatory Health Care Facilities | Clinic/Center | Oral and Maxillofacial Surgery | 261QS0112X | 07882 | IA | N | Ambulatory Health Care Facilities | Clinic/Center | Oral and Maxillofacial Surgery | 261QS0112X | 7879 | IA | Y | Ambulatory Health Care Facilities | Clinic/Center | Oral and Maxillofacial Surgery |
No ID Information.