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General NPI Number Information
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NPI Number | 1134437080
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Entity Type | Organization
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Legal Business Name | ERIKA E PEDDICORD, DDS, PLC
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Dates
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Enumeration Date | 09/14/2010
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Last Update Date | 09/09/2013
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Provider Practice Location Address
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Address Line | 121 NE 18TH ST STE C
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City | ANKENY
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State | IA
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Zip | 50021-4697
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Country | US
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Telephone | 515-963-3339
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Fax |
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Provider Business Mailing Address
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Address Line | 121 NE 18TH ST STE C
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City | ANKENY
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State | IA
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Zip | 50021-4697
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Country | US
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Telephone | 515-963-3339
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. ERIKA ELLEN PEDDICORD
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Credential | D.D.S.
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Telephone | 515-963-3339
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 08497
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License Number State | IA
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