Healthcare Provider Details

I. General information

NPI: 1174074967
Provider Name (Legal Business Name): DYLAN THOMAS HENGST D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2016
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 6TH AVE
DES MOINES IA
50314-2613
US

IV. Provider business mailing address

1111 6TH AVE
DES MOINES IA
50314-2613
US

V. Phone/Fax

Practice location:
  • Phone: 515-235-5000
  • Fax: 515-288-6713
Mailing address:
  • Phone: 515-235-5000
  • Fax: 515-288-6713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberDO-55693
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberR-12880
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: