Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | DDS-09177 | IA |
NPI | 1043507890 |
---|---|
Provider Name | Molly Bremen |
First Address | Des Moines, IA 50321-3111 |
Second Address | Des Moines, IA 50321-3111 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2011 |
Last Update Date | 02/03/2020 |