MEDICARE: COMPLETE FAMILY DENTISTRY

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	6546	NE

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

General Provider Information

NPI Number	:	1871028159
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPLETE FAMILY DENTISTRY

Provider Business Mailing Address
First Line	:	9635 KOI ROCK DR
Second Line	:
City	:	LINCOLN
State	:	NE
Zip	:	68526-9678
Country	:	US
Telephone Number	:	402-499-0624
Fax Number	:

Provider Business Practice Location Address
First Line	:	9635 KOI ROCK DR
Second Line	:
City	:	LINCOLN
State	:	NE
Zip	:	68526-9678
Country	:	US
Telephone Number	:	402-499-0624
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	FARRAH PLATE
Credential	:	DR.
Telephone Number	:	402-499-0624

Provider Enumeration Date	:	04/25/2017
Last Update Date	:	02/12/2024

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Directions to “COMPLETE FAMILY DENTISTRY ” Practice Location

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