Provider Demographics
NPI:1003182783
Name:ISLAND VIEW DENTAL P.C.
Entity Type:Organization
Organization Name:ISLAND VIEW DENTAL P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:VOLNEY
Authorized Official - Last Name:LOFGREEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:308-381-0167
Mailing Address - Street 1:638 N. WEBB RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68803-4057
Mailing Address - Country:US
Mailing Address - Phone:308-381-0167
Mailing Address - Fax:308-381-6689
Practice Address - Street 1:638 N. WEBB RD
Practice Address - Street 2:SUITE 1
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-4057
Practice Address - Country:US
Practice Address - Phone:308-381-0167
Practice Address - Fax:308-381-6689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-28
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE42581223G0001X
NE62821223G0001X
NE42641223G0001X
NE56631223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty