Provider Demographics
NPI:1609030337
Name:ANCELL FAMILY DENTISTRY
Entity Type:Organization
Organization Name:ANCELL FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:WADE
Authorized Official - Last Name:ANCELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:515-226-9800
Mailing Address - Street 1:800 S 50TH ST
Mailing Address - Street 2:STE. 105
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50265-5381
Mailing Address - Country:US
Mailing Address - Phone:515-226-9800
Mailing Address - Fax:515-226-9804
Practice Address - Street 1:800 S 50TH ST
Practice Address - Street 2:STE. 105
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50265-5381
Practice Address - Country:US
Practice Address - Phone:515-226-9800
Practice Address - Fax:515-226-9804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-11
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA08114IA1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty