Provider Demographics
NPI:1093458945
Name:TRAIL VIEW DENTAL LLC
Entity type:Organization
Organization Name:TRAIL VIEW DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JORY
Authorized Official - Middle Name:T
Authorized Official - Last Name:CROUCH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:308-380-7622
Mailing Address - Street 1:2916 W STOLLEY PARK RD STE A
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68801-6808
Mailing Address - Country:US
Mailing Address - Phone:083-821-7343
Mailing Address - Fax:
Practice Address - Street 1:2916 W STOLLEY PARK RD STE A
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68801-6808
Practice Address - Country:US
Practice Address - Phone:308-380-7622
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-19
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental