Individual
DR. PHELAN RICO THOMAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
4100 UNIVERSITY AVE, SUITE 105, WEST DES MOINES, IA 50266-5956
(515) 223-8800
(515) 223-1437
Mailing address
4100 UNIVERSITY AVE STE 105, WEST DES MOINES, IA 50266-5958
(515) 223-8800
(515) 223-1437
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
07198
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
07198
DENTAL LICENSE NUMBER
IA
Enumeration date
11/16/2006
Last updated
07/08/2007
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