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General NPI Number Information
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NPI Number | 1205015039
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Entity Type | Organization
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Legal Business Name | KEARNEY DENTAL CLINIC P C
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Dates
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Enumeration Date | 10/29/2007
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | 4106 6TH AVE
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City | KEARNEY
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State | NE
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Zip | 68845-3395
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Country | US
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Telephone | 308-237-3281
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Fax | 308-236-9642
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Provider Business Mailing Address
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Address Line | 4106 6TH AVE
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City | KEARNEY
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State | NE
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Zip | 68845-3395
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Country | US
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Telephone | 308-237-3479
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Fax | 308-236-9642
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. STEPHEN R BUSH
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Credential | D.D.S.
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Telephone | 308-237-3479
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 6551
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License Number State | NE
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 5333
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License Number State | NE
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