Provider Demographics
NPI:1033684733
Name:NELIGH FAMILY DENTISTRY, LLC
Entity Type:Organization
Organization Name:NELIGH FAMILY DENTISTRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:BROVONT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-887-5214
Mailing Address - Street 1:322 M ST
Mailing Address - Street 2:
Mailing Address - City:NELIGH
Mailing Address - State:NE
Mailing Address - Zip Code:68756-1421
Mailing Address - Country:US
Mailing Address - Phone:402-887-5214
Mailing Address - Fax:
Practice Address - Street 1:322 M ST
Practice Address - Street 2:
Practice Address - City:NELIGH
Practice Address - State:NE
Practice Address - Zip Code:68756-1421
Practice Address - Country:US
Practice Address - Phone:402-887-5214
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-09
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026675000Medicaid