MEDICARE: FAMILY FIRST DENTAL ASSOCIATES OF COLUMBUS, P.C.

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	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1083880751
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY FIRST DENTAL ASSOCIATES OF COLUMBUS, P.C.

Provider Business Mailing Address
First Line	:	2672 33RD AVE
Second Line	:
City	:	COLUMBUS
State	:	NE
Zip	:	68601-2314
Country	:	US
Telephone Number	:	402-564-7575
Fax Number	:

Provider Business Practice Location Address
First Line	:	2672 33RD AVE
Second Line	:
City	:	COLUMBUS
State	:	NE
Zip	:	68601-2314
Country	:	US
Telephone Number	:	402-564-7575
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. CHARLES S. SKOGLUND
Credential	:	DDS
Telephone Number	:	402-644-3177

Provider Enumeration Date	:	05/02/2008
Last Update Date	:	05/02/2008

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