Healthcare Provider Details

I. General information

NPI: 1629601075
Provider Name (Legal Business Name): PLATTSMOUTH DENTAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2020
Last Update Date: 02/13/2020
Certification Date: 02/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

619 MAIN ST
PLATTSMOUTH NE
68048-1853
US

IV. Provider business mailing address

619 MAIN ST
PLATTSMOUTH NE
68048-1853
US

V. Phone/Fax

Practice location:
  • Phone: 402-296-2188
  • Fax: 402-296-4480
Mailing address:
  • Phone: 402-296-2188
  • Fax: 402-296-4480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: BRITTANY KING
Title or Position: OFFICE MANAGER
Credential:
Phone: 402-991-9423