Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 8083 | IA |
NPI | 1043348360 |
---|---|
Provider Name | Dr. Dawn Marie Stultz |
First Address | Coralville, IA 52241-2416 |
Second Address | Coralville, IA 52241-2416 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/02/2007 |
Last Update Date | 08/07/2007 |