Provider Demographics
NPI:1053355586
Name:NIELSEN, TODD E (DDS)
Entity type:Individual
Prefix:DR
First Name:TODD
Middle Name:E
Last Name:NIELSEN
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 1:1469 29TH ST
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-1302
Mailing Address - Country:US
Mailing Address - Phone:515-223-6529
Mailing Address - Fax:515-223-5448
Practice Address - Street 1:1469 29TH ST
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-1302
Practice Address - Country:US
Practice Address - Phone:515-223-6529
Practice Address - Fax:515-223-5448
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20030037241223P0106X
IA084151223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOU57195Medicare UPIN