Healthcare Provider Details

I. General information

NPI: 1366609299
Provider Name (Legal Business Name): HOLST OLBERDING FAMILY DENTISTRY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2008
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 50TH ST. EP TRUE DENTAL
WEST DES MOINES IA
50265
US

IV. Provider business mailing address

275 50TH ST. EP TRUE DENTAL
WEST DES MOINES IA
50265
US

V. Phone/Fax

Practice location:
  • Phone: 515-224-9899
  • Fax:
Mailing address:
  • Phone: 515-224-9899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number7380
License Number StateIA

VIII. Authorized Official

Name: DR. LISA KIM HOLST
Title or Position: DENTIST/OWNER
Credential: DDS
Phone: 515-224-9899