Provider Demographics
NPI:1053183558
Name:RESTORATION DENTAL AND IMPLANT CENTER, PC
Entity type:Organization
Organization Name:RESTORATION DENTAL AND IMPLANT CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:CHAD
Authorized Official - Last Name:DE BOEF
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:641-673-3008
Mailing Address - Street 1:105 HIGH AVE EAST
Mailing Address - Street 2:
Mailing Address - City:OSKALOOSA
Mailing Address - State:IA
Mailing Address - Zip Code:52577
Mailing Address - Country:US
Mailing Address - Phone:641-673-3008
Mailing Address - Fax:
Practice Address - Street 1:1004 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:IA
Practice Address - Zip Code:52353
Practice Address - Country:US
Practice Address - Phone:319-653-2201
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-27
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty