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NPI Code Detail

MEDICARE: MISSOURI VALLEY DENTAL GROUP, LLC

MEDICARE: MISSOURI VALLEY DENTAL GROUP, 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
11223G0001XGeneral Practice Dentistry

Other Identifiers

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

General Provider Information

NPI Number : 1437467628
Entity Type Code : Organization
Provider Name (Legal Business Name) : MISSOURI VALLEY DENTAL GROUP, LLC
Provider Business Mailing Address
First Line : 11110 FORT ST STE 106&107
Second Line :
City : OMAHA
State : NE
Zip : 68164-2183
Country : US
Telephone Number : 402-492-8300
Fax Number :
Provider Business Practice Location Address
First Line : 11110 FORT ST STE 106&107
Second Line :
City : OMAHA
State : NE
Zip : 68164-2183
Country : US
Telephone Number : 402-492-8300
Fax Number :
Authorized Official
Title or Position : CORPORATE SECRETARY
Name : JEAN ANN KERGER
Credential :
Telephone Number : 402-492-8300
Provider Enumeration Date : 09/22/2010
Last Update Date : 09/22/2010

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Directions to “MISSOURI VALLEY DENTAL GROUP, LLC ” Practice Location

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