Basic Information
Provider Information
NPI: 1003142688
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SMITH
FirstName: NICHOLAS
MiddleName: RINDELS
NamePrefix: DR.
NameSuffix:  
Credential: D.D.S., M.S.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2575 N. ANKENY BLVD.
Address2: SUITE #205
City: ANKENY
State: IA
PostalCode: 50023
CountryCode: US
TelephoneNumber: 5159652672
FaxNumber:  
Practice Location
Address1: 2575 N. ANKENY BLVD.
Address2: SUITE #205
City: ANKENY
State: IA
PostalCode: 50023
CountryCode: US
TelephoneNumber: 5159652672
FaxNumber:  
Other Information
ProviderEnumerationDate: 11/02/2009
LastUpdateDate: 12/22/2011
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1223X0400X08798IAY Dental ProvidersDentistOrthodontics and Dentofacial Orthopedics

No ID Information.


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