Provider Demographics
NPI:1215493390
Name:LOUP VALLEY DENTAL
Entity type:Organization
Organization Name:LOUP VALLEY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:ARIELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRINKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:308-728-5672
Mailing Address - Street 1:1730 M ST
Mailing Address - Street 2:
Mailing Address - City:ORD
Mailing Address - State:NE
Mailing Address - Zip Code:68862-1304
Mailing Address - Country:US
Mailing Address - Phone:308-728-5672
Mailing Address - Fax:308-728-7995
Practice Address - Street 1:1730 M ST
Practice Address - Street 2:
Practice Address - City:ORD
Practice Address - State:NE
Practice Address - Zip Code:68862-1304
Practice Address - Country:US
Practice Address - Phone:308-728-5672
Practice Address - Fax:308-728-7995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-14
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty