Provider Demographics
NPI:1386339802
Name:PEDIATRIC DENTAL SPECIALISTS OF GREATER NEBRASKA - KEARNEY LLC
Entity type:Organization
Organization Name:PEDIATRIC DENTAL SPECIALISTS OF GREATER NEBRASKA - KEARNEY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-462-6557
Mailing Address - Street 1:121 E 31ST ST
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68847-3001
Mailing Address - Country:US
Mailing Address - Phone:308-234-5437
Mailing Address - Fax:
Practice Address - Street 1:121 E 31ST ST
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68847-3001
Practice Address - Country:US
Practice Address - Phone:308-234-5437
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-10
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty