Provider Demographics
NPI:1457697153
Name:AINSWORTH DENTAL CLINIC LLC
Entity type:Organization
Organization Name:AINSWORTH DENTAL CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:PATTERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:402-387-2404
Mailing Address - Street 1:255 N MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:AINSWORTH
Mailing Address - State:NE
Mailing Address - Zip Code:69210-1420
Mailing Address - Country:US
Mailing Address - Phone:402-387-2404
Mailing Address - Fax:402-387-2410
Practice Address - Street 1:255 N MAPLE ST
Practice Address - Street 2:
Practice Address - City:AINSWORTH
Practice Address - State:NE
Practice Address - Zip Code:69210-1420
Practice Address - Country:US
Practice Address - Phone:402-387-2404
Practice Address - Fax:402-387-2410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-27
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty