MEDICARE: DENNIS E PESTAL DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	4570	NE

General Provider Information

NPI Number	:	1972795466
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENNIS E PESTAL DDS

Provider Business Mailing Address
First Line	:	3000 LINCOLN ST
Second Line	:	BEATRICE STATE DEVELOPMENT CENTER DENTAL CLINIC
City	:	BEATRICE
State	:	NE
Zip	:	68310-3319
Country	:	US
Telephone Number	:	402-223-7246
Fax Number	:	402-223-7589

Provider Business Practice Location Address
First Line	:	3000 LINCOLN ST
Second Line	:	BEATRICE STATE DEVELOPMENT CENTER DENTAL CLINIC
City	:	BEATRICE
State	:	NE
Zip	:	68310-3319
Country	:	US
Telephone Number	:	402-223-7246
Fax Number	:	402-223-7589

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/17/2007
Last Update Date	:	08/17/2007

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