| Organization Name: | ERIKA E PEDDICORD, DDS, PLC |
| NPI Number: | 1134437080 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ERIKA ELLEN PEDDICORD (OWNER) |
| Mailing Address: | 121 Ne 18th St Ste C Ankeny |
| State: | IA US |
| Postal Code: | 500214697 |
| Phone Number: | 5159633339 |
| Fax Number: | |
| NPI Enumeration Date: | 09/14/2010 |
| NPI Last Update Date: | 09/09/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | 08497 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IA |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |