Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0106X | Oral and Maxillofacial Pathology | 2003003724 | MO |
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 08415 | IA |
NPI | 1053355586 |
---|---|
Provider Name | Dr. Todd E. Nielsen |
First Address | West Des Moines, IA 50266-1302 |
Second Address | West Des Moines, IA 50266-1302 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2006 |
Last Update Date | 12/03/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U57195 | (02) | MO |