Provider Demographics
NPI:1235110685
Name:DUBUQUE ENT HEAD & NECK SURGERY P.C.
Entity type:Organization
Organization Name:DUBUQUE ENT HEAD & NECK SURGERY P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:BENDA
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:563-588-0506
Mailing Address - Street 1:535 CEDAR CROSS ROAD
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52003-7704
Mailing Address - Country:US
Mailing Address - Phone:563-588-0506
Mailing Address - Fax:563-588-0451
Practice Address - Street 1:535 CEDAR CROSS ROAD
Practice Address - Street 2:
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52003-7704
Practice Address - Country:US
Practice Address - Phone:563-588-0506
Practice Address - Fax:563-588-0451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-10
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA07027OtherWELLMARK BCBS IA
IA0070276Medicaid
IA547049OtherDEAN HEALTH PLAN
IA547049OtherDEAN HEALTH PLAN