Healthcare Provider Details

I. General information

NPI: 1972795466
Provider Name (Legal Business Name): DENNIS E PESTAL DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2007
Last Update Date: 08/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 LINCOLN ST BEATRICE STATE DEVELOPMENT CENTER DENTAL CLINIC
BEATRICE NE
68310-3319
US

IV. Provider business mailing address

3000 LINCOLN ST BEATRICE STATE DEVELOPMENT CENTER DENTAL CLINIC
BEATRICE NE
68310-3319
US

V. Phone/Fax

Practice location:
  • Phone: 402-223-7246
  • Fax: 402-223-7589
Mailing address:
  • Phone: 402-223-7246
  • Fax: 402-223-7589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number4570
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: