NPI: 1164928388 · URBANDALE, IA 50322 · Dental Clinic/Center · NPI assigned 04/05/2018
| Authorized Official | DAVIDSON, DIANE (CLINIC ADMIN.) |
| NPI Enumeration Date | 04/05/2018 |
| Year | Claims | Total Paid |
|---|---|---|
| 2021 | 13 | $262.23 |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| D0120 | Periodic oral evaluation - established patient | 13 | 13 | $262.23 |