Provider Demographics
NPI:1972795466
Name:PESTAL, DENNIS E (DDS)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:E
Last Name:PESTAL
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 1:3000 LINCOLN ST
Mailing Address - Street 2:BEATRICE STATE DEVELOPMENT CENTER DENTAL CLINIC
Mailing Address - City:BEATRICE
Mailing Address - State:NE
Mailing Address - Zip Code:68310-3319
Mailing Address - Country:US
Mailing Address - Phone:402-223-7246
Mailing Address - Fax:402-223-7589
Practice Address - Street 1:3000 LINCOLN ST
Practice Address - Street 2:BEATRICE STATE DEVELOPMENT CENTER DENTAL CLINIC
Practice Address - City:BEATRICE
Practice Address - State:NE
Practice Address - Zip Code:68310-3319
Practice Address - Country:US
Practice Address - Phone:402-223-7246
Practice Address - Fax:402-223-7589
Is Sole Proprietor?:No
Enumeration Date:2007-08-17
Last Update Date:2007-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE4570122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist