Healthcare Provider Details

I. General information

NPI: 1346022068
Provider Name (Legal Business Name): CHILDRENS DENTAL SURGERY ASSOCIATES PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2023
Last Update Date: 10/17/2023
Certification Date: 10/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1551 SE 3RD ST STE 100
GRIMES IA
50111-8803
US

IV. Provider business mailing address

1551 SE 3RD ST STE 100
GRIMES IA
50111-8803
US

V. Phone/Fax

Practice location:
  • Phone: 515-776-1136
  • Fax: 515-864-0507
Mailing address:
  • Phone: 515-776-1136
  • Fax: 515-864-0507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. NICHOLAS WADE BARNARD
Title or Position: PEDIATRIC DENTIST
Credential: DDS
Phone: 515-776-1136