Healthcare Provider Details

I. General information

NPI: 1730972472
Provider Name (Legal Business Name): PLATTE RIVER ORTHODONTICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2025
Last Update Date: 05/26/2025
Certification Date: 05/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11844 STANDING STONE DR STE 100
GRETNA NE
68028-8111
US

IV. Provider business mailing address

11844 STANDING STONE DR STE 100
GRETNA NE
68028-8111
US

V. Phone/Fax

Practice location:
  • Phone: 402-322-8838
  • Fax:
Mailing address:
  • Phone: 402-322-8838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number StateNULL

VIII. Authorized Official

Name: CHAD CARTER
Title or Position: OWNER
Credential: DDS
Phone: 402-322-8838