Peter L. Vidal, D.D.S

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

6152 Issued in IA

Practice address

160 W 4TH St
Garner, IA 50438-1329

Phone

(641) 923-2294

Fax

(641) 923-3140

NPI assigned

Jan 9, 2007

Last updated

Mar 18, 2022By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Vidal Family Dentistry

  • General Practice Dentistry
  • Garner, IA
  • NPI 1790415735
  NPD (past)

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

{
    "created_epoch": "1168300800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1647561600000",
    "number": "1821147851",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "160 W 4TH ST",
            "address_2": "P. O. BOX 10",
            "city": "GARNER",
            "state": "IA",
            "postal_code": "504381329",
            "telephone_number": "641-923-2294",
            "fax_number": "641-923-3140"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "160 W 4TH ST",
            "city": "GARNER",
            "state": "IA",
            "postal_code": "504381329",
            "telephone_number": "641-923-2294",
            "fax_number": "641-923-3140"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VIDAL",
        "first_name": "PETER",
        "middle_name": "L.",
        "name_prefix": "Dr.",
        "credential": "D.D.S",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-09",
        "last_updated": "2022-03-18",
        "certification_date": "2022-03-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IA",
            "license": "6152",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0132209",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• John Lee Steenblock
• Roy A Tesene, DDS
• Kendra S Ulicki, ANRP
• Alexander P Vangerpen, DDS
• Vidal Family Dentistry
• Cassie J Wagner, NP
• Scott Bradley Wood, D.C.
• Deena Marie Zadow, ARNP
• Hilary Zrostlik, ARNP

• General Practice Dentistry in Garner, IA
• Providers in Garner, IA by specialty
• General Practice Dentistry in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.