Provider Demographics
NPI:1588436240
Name:DYER'S DENTAL GROUP, PC
Entity type:Organization
Organization Name:DYER'S DENTAL GROUP, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RIKKI
Authorized Official - Middle Name:
Authorized Official - Last Name:LIEBERTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-505-6843
Mailing Address - Street 1:6606 S 168TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68135-5420
Mailing Address - Country:US
Mailing Address - Phone:402-505-6843
Mailing Address - Fax:
Practice Address - Street 1:2650 21ST ST STE 4
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95818-2539
Practice Address - Country:US
Practice Address - Phone:402-505-6843
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-26
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental