Provider Demographics
NPI:1245329945
Name:TODD, DAN THOMAS (DDS)
Entity type:Individual
Prefix:DR
First Name:DAN
Middle Name:THOMAS
Last Name:TODD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1454 30TH ST
Mailing Address - Street 2:SUITE 208B
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-1305
Mailing Address - Country:US
Mailing Address - Phone:515-225-2577
Mailing Address - Fax:515-223-0793
Practice Address - Street 1:1454 30TH ST
Practice Address - Street 2:SUITE 208B
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-1305
Practice Address - Country:US
Practice Address - Phone:515-225-2577
Practice Address - Fax:515-223-0793
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA067021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0183210Medicaid