=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164130332
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WEST HIGHLAND DENTAL LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/07/2022
-----------------------------------------------------
Last Update Date | 05/21/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2100 S 20TH ST STE 3
-----------------------------------------------------
City | BLAIR
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68008-2398
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 531-910-7980
-----------------------------------------------------
Fax | 531-910-7980
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2100 S 20TH ST STE 3
-----------------------------------------------------
City | BLAIR
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68008-2398
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 531-910-7980
-----------------------------------------------------
Fax | 531-910-7959
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DENTIST / OWNER
-----------------------------------------------------
Name | DR. BROCK BERNARD LEWIS
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 402-646-5449
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------