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General NPI Number Information
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NPI Number | 1790315166
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Entity Type | Organization
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Legal Business Name | THE NEST PEDIATRIC DENTISTRY, PC
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Dates
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Enumeration Date | 01/24/2020
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Last Update Date | 01/24/2020
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Provider Practice Location Address
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Address Line | 1250 SE UNIVERSITY AVE
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City | WAUKEE
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State | IA
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Zip | 50263-5026
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Country | US
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Telephone | 515-650-6378
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Fax |
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Provider Business Mailing Address
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Address Line | 5510 PONDEROSA DR
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City | WEST DES MOINES
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State | IA
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Zip | 50266-2841
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Country | US
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Telephone | 563-343-5903
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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. DIANA PELZER
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Credential | DDS
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Telephone | 515-650-6378
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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