MEDICARE: SIMPLY SMILES DENTISTRY OF COLUMBUS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013715531
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SIMPLY SMILES DENTISTRY OF COLUMBUS LLC

Provider Business Mailing Address
First Line	:	2526 17TH ST
Second Line	:
City	:	COLUMBUS
State	:	NE
Zip	:	68601-4349
Country	:	US
Telephone Number	:	402-564-4408
Fax Number	:	402-564-4409

Provider Business Practice Location Address
First Line	:	2526 17TH ST
Second Line	:
City	:	COLUMBUS
State	:	NE
Zip	:	68601-4349
Country	:	US
Telephone Number	:	402-564-4408
Fax Number	:	402-564-4409

Authorized Official
Title or Position	:	DENTIST/OWNER
Name	:	DR. REBECCA ANN RONKAR-HISSONG
Credential	:	DDS
Telephone Number	:	402-564-4408

Provider Enumeration Date	:	03/03/2025
Last Update Date	:	03/03/2025

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