Healthcare Provider Details

I. General information

NPI: 1710523097
Provider Name (Legal Business Name): TODAY'S DENTAL BELLEVUE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2019
Last Update Date: 01/12/2024
Certification Date: 01/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2207 LONGO DRIVE
BELLEVUE NE
68005
US

IV. Provider business mailing address

27330 W CENTER RD
WATERLOO NE
68069-6814
US

V. Phone/Fax

Practice location:
  • Phone: 402-291-4411
  • Fax:
Mailing address:
  • Phone: 701-799-6453
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: BRENT RISING
Title or Position: OWNER,MANAGER
Credential: DDS
Phone: 701-799-6453