Healthcare Provider Details

I. General information

NPI: 1841100716
Provider Name (Legal Business Name): PARKSIDE PERIODONTAL AND IMPLANT CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 S MAPLE ST
NORTH PLATTE NE
69101-5282
US

IV. Provider business mailing address

805 S MAPLE ST
NORTH PLATTE NE
69101-5282
US

V. Phone/Fax

Practice location:
  • Phone: 308-534-1289
  • Fax: 308-534-1530
Mailing address:
  • Phone: 308-534-1289
  • Fax: 308-534-1530

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State

VIII. Authorized Official

Name: BENJAMIN LASHLEY
Title or Position: OWNER
Credential: DDS
Phone: 308-534-1289