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General NPI Number Information
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NPI Number | 1295007235
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Entity Type | Organization
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Legal Business Name | FAMILY FIRST DENTAL ASSOCIATES OF NEBRASKA, PC
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Dates
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Enumeration Date | 02/07/2012
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Last Update Date | 02/07/2012
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Provider Practice Location Address
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Address Line | 2104 TAYLOR AVE
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City | NORFOLK
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State | NE
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Zip | 68701-4640
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Country | US
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Telephone | 402-371-6566
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Fax |
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Provider Business Mailing Address
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Address Line | 2104 TAYLOR AVE.
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City | NORFOLK
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State | NE
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Zip | 68701-3283
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Country | US
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Telephone | 402-371-6566
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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. CHARLES S SKOGLUND
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Credential | DDS
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Telephone | 402-644-3177
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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 | 4961
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License Number State | NE
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