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General NPI Number Information
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NPI Number | 1184500241
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Entity Type | Organization
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Legal Business Name | FULL CIRCLE DENTAL
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Dates
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Enumeration Date | 08/14/2025
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Last Update Date | 08/14/2025
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Provider Practice Location Address
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Address Line | 102 W SENECA ST
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City | RAVENNA
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State | NE
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Zip | 68869-1363
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Country | US
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Telephone | 308-455-7069
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Fax |
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Provider Business Mailing Address
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Address Line | 102 W SENECA ST
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City | RAVENNA
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State | NE
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Zip | 68869-1363
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Country | US
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Telephone | 308-455-7069
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. ALIVIA GRACE FOCKEN
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Credential | DDS
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Telephone | 308-440-1540
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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