Healthcare Provider Details

I. General information

NPI: 1548195308
Provider Name (Legal Business Name): TD DENTAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 2ND ST
FRIEND NE
68359-1134
US

IV. Provider business mailing address

213 S WATER ST
CLINTON MO
64735-2036
US

V. Phone/Fax

Practice location:
  • Phone: 402-947-5111
  • Fax:
Mailing address:
  • Phone: 402-381-8909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TRUC DOAN
Title or Position: DENTIST
Credential: DDS
Phone: 402-381-8909