Provider Demographics
NPI:1457401770
Name:NESTER, DALE A (DDS)
Entity Type:Individual
Prefix:DR
First Name:DALE
Middle Name:A
Last Name:NESTER
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 1:610 N PINE RIVER ST
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:MI
Mailing Address - Zip Code:48847-1167
Mailing Address - Country:US
Mailing Address - Phone:989-875-2888
Mailing Address - Fax:989-875-4604
Practice Address - Street 1:610 N PINE RIVER ST
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:MI
Practice Address - Zip Code:48847-1167
Practice Address - Country:US
Practice Address - Phone:989-875-2888
Practice Address - Fax:989-875-4604
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI122041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4050207Medicaid