Provider Demographics
NPI:1871714758
Name:GROELTZ, AMY REBECCA (DDS)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:REBECCA
Last Name:GROELTZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 HEDGE AVE
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52601-6435
Mailing Address - Country:US
Mailing Address - Phone:319-753-0424
Mailing Address - Fax:
Practice Address - Street 1:210 SOUTH 5TH STREET
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:IA
Practice Address - Zip Code:52601
Practice Address - Country:US
Practice Address - Phone:319-752-1600
Practice Address - Fax:319-752-1610
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA08298122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist