Provider Demographics
NPI:1427642206
Name:BLUEJAY FAMILY DENTAL PC
Entity type:Organization
Organization Name:BLUEJAY FAMILY DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:NICHOLAS
Authorized Official - Last Name:FIDONE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:402-208-3571
Mailing Address - Street 1:1860 MADISON AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51503-5200
Mailing Address - Country:US
Mailing Address - Phone:712-256-6263
Mailing Address - Fax:
Practice Address - Street 1:1860 MADISON AVE STE 4
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-5200
Practice Address - Country:US
Practice Address - Phone:712-256-6263
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-23
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty