Provider Demographics
NPI:1215647805
Name:METRO WEST DENTAL SPECIALTY GROUP
Entity type:Organization
Organization Name:METRO WEST DENTAL SPECIALTY GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:MURILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-999-1016
Mailing Address - Street 1:12225 W GILES RD
Mailing Address - Street 2:
Mailing Address - City:LA VISTA
Mailing Address - State:NE
Mailing Address - Zip Code:68128-5801
Mailing Address - Country:US
Mailing Address - Phone:402-614-7022
Mailing Address - Fax:402-614-7122
Practice Address - Street 1:12225 W GILES RD
Practice Address - Street 2:
Practice Address - City:LA VISTA
Practice Address - State:NE
Practice Address - Zip Code:68128-5801
Practice Address - Country:US
Practice Address - Phone:402-614-7022
Practice Address - Fax:402-614-7122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-05
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE1366625816OtherNPI
NE1376730143OtherNPI
NE1982802096OtherNPI