Provider Demographics
NPI:1588781306
Name:SPECIALTY DENTAL CARE PC
Entity type:Organization
Organization Name:SPECIALTY DENTAL CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARSHA
Authorized Official - Middle Name:K
Authorized Official - Last Name:MCBRATNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-334-8083
Mailing Address - Street 1:12242 K PLZ
Mailing Address - Street 2:SUITE 113
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68137-2260
Mailing Address - Country:US
Mailing Address - Phone:402-334-8083
Mailing Address - Fax:402-334-0834
Practice Address - Street 1:12165 W CENTER RD
Practice Address - Street 2:SUITE 76
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-3962
Practice Address - Country:US
Practice Address - Phone:402-334-8083
Practice Address - Fax:402-334-0834
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-25
Last Update Date:2011-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NENE43321223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty