Provider Demographics
NPI:1134495849
Name:MINDEN DENTAL CLINIC, LLC
Entity Type:Organization
Organization Name:MINDEN DENTAL CLINIC, LLC
Other - Org Name:CHRISTOPHER L BIRKESTRAND, DDS LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DOCTOR/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:BIRKESTRAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:308-832-2582
Mailing Address - Street 1:110 E HAWTHORNE ST
Mailing Address - Street 2:
Mailing Address - City:MINDEN
Mailing Address - State:NE
Mailing Address - Zip Code:68959-1971
Mailing Address - Country:US
Mailing Address - Phone:308-832-2582
Mailing Address - Fax:308-832-1120
Practice Address - Street 1:110 E HAWTHORNE ST
Practice Address - Street 2:
Practice Address - City:MINDEN
Practice Address - State:NE
Practice Address - Zip Code:68959-1971
Practice Address - Country:US
Practice Address - Phone:308-832-2582
Practice Address - Fax:308-832-1120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-27
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE62571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========00Medicaid