Healthcare Provider Details

I. General information

NPI: 1659851814
Provider Name (Legal Business Name): TAYLOR TODD HENRY NIELSEN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2018
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 GRAND AVE STE 150
DES MOINES IA
50309-8014
US

IV. Provider business mailing address

5877 N CANYON RIM RD
LEHI UT
84048-6948
US

V. Phone/Fax

Practice location:
  • Phone: 515-243-3419
  • Fax:
Mailing address:
  • Phone: 515-243-3419
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number09626
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD10886
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: