Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | DDS-09914 | IA |
NPI | 1003485616 |
---|---|
Provider Name | Dr. Hannah Klaassen |
First Address | Coralville, IA 52241-2480 |
Second Address | Cedar Rapids, IA 52404-6308 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2021 |
Last Update Date | 18/06/2021 |