Healthcare Provider Details

I. General information

NPI: 1285737882
Provider Name (Legal Business Name): BLUE DRAGONFLY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 NELSON ST
CAMBRIDGE NE
69022-0057
US

IV. Provider business mailing address

PO BOX 57 307 NELSON ST
CAMBRIDGE NE
69022-0057
US

V. Phone/Fax

Practice location:
  • Phone: 308-697-3736
  • Fax: 308-692-3705
Mailing address:
  • Phone: 308-697-3736
  • Fax: 308-692-3705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. DEAN DARLINGTON COPE
Title or Position: OWNER OFFICER
Credential: DDS
Phone: 308-697-3736