Healthcare Provider Details

I. General information

NPI: 1366968711
Provider Name (Legal Business Name): MELISSA M SCHOCK DDS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2017
Last Update Date: 01/09/2025
Certification Date: 01/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 4TH ST
FULLERTON NE
68638-3119
US

IV. Provider business mailing address

PO BOX 665
FULLERTON NE
68638-0665
US

V. Phone/Fax

Practice location:
  • Phone: 308-536-2120
  • Fax: 308-536-2559
Mailing address:
  • Phone: 308-536-2120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number7370
License Number StateNE

VIII. Authorized Official

Name: MELISSA M SCHOCK
Title or Position: DR.
Credential: D.D.S.
Phone: 402-366-9507