Individual provider Active NPI

Todd E. Nielsen, DDS

  • Oral and Maxillofacial Surgery (Dentist)
  • West Des Moines, IA
National Provider Identifier
1053355586
Registry record updated Mar 12, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
License
08415 Issued in IA
Practice address
1469 29TH St
West Des Moines, IA 50266-1302
Phone
(515) 223-6529
Fax
(515) 223-5448
NPI assigned
Jun 15, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 12, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Pathology Dentistry 1223P0106X 2003003724 MO
Oral and Maxillofacial Surgery (Dentist) 1223S0112X 08415 IA Primary

Addresses

Primary practice location

1469 29TH St
West Des Moines, IA 50266-1302

Mailing address

1469 29TH St
West Des Moines, IA 50266-1302
Phone (515) 223-6529

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080730000524 IA Practitioner - Oral Surgery 0143394726

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2003003724MOMDOral and Maxillofacial Pathology Dentist
08415IAMDOral and Maxillofacial Surgery (Dentist)

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1150329600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1205280000000",
    "number": "1053355586",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1469 29TH ST",
            "city": "WEST DES MOINES",
            "state": "IA",
            "postal_code": "502661302",
            "telephone_number": "515-223-6529",
            "fax_number": "515-223-5448"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1469 29TH ST",
            "city": "WEST DES MOINES",
            "state": "IA",
            "postal_code": "502661302",
            "telephone_number": "515-223-6529",
            "fax_number": "515-223-5448"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NIELSEN",
        "first_name": "TODD",
        "middle_name": "E.",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-15",
        "last_updated": "2008-03-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0106X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Pathology",
            "state": "MO",
            "license": "2003003724",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "IA",
            "license": "08415",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in West Des Moines, IA

Sources for this page

Verify at the official NPI Registry.