Provider Demographics
NPI:1053579201
Name:ORAL HEALTH CLINIC PC
Entity type:Organization
Organization Name:ORAL HEALTH CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHADWICK
Authorized Official - Middle Name:AARON
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:515-266-3700
Mailing Address - Street 1:1225 COPPER CREEK DR SUITE K
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:IA
Mailing Address - Zip Code:50327-7091
Mailing Address - Country:US
Mailing Address - Phone:515-266-3700
Mailing Address - Fax:515-266-3597
Practice Address - Street 1:1225 COPPER CREEK DR SUITE K
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:IA
Practice Address - Zip Code:50327-7091
Practice Address - Country:US
Practice Address - Phone:515-266-3700
Practice Address - Fax:515-266-3597
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-23
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA8353261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0462705Medicaid