Provider Demographics
NPI:1699046367
Name:EXCLUSIVELY ORTHODONTICS LLC
Entity type:Organization
Organization Name:EXCLUSIVELY ORTHODONTICS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:J
Authorized Official - Last Name:HURD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MSD
Authorized Official - Phone:402-339-0506
Mailing Address - Street 1:955 N ADAMS ST
Mailing Address - Street 2:SUITE 8
Mailing Address - City:PAPILLION
Mailing Address - State:NE
Mailing Address - Zip Code:68046-3063
Mailing Address - Country:US
Mailing Address - Phone:402-339-0506
Mailing Address - Fax:402-339-3287
Practice Address - Street 1:955 N ADAMS ST
Practice Address - Street 2:SUITE 8
Practice Address - City:PAPILLION
Practice Address - State:NE
Practice Address - Zip Code:68046-3063
Practice Address - Country:US
Practice Address - Phone:402-339-0506
Practice Address - Fax:402-339-3287
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-25
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE41361223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty