Provider Demographics
NPI:1225109887
Name:NORFOLK DENTAL GROUP LLP
Entity Type:Organization
Organization Name:NORFOLK DENTAL GROUP LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:MERRITT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:402-371-1360
Mailing Address - Street 1:PO BOX 1203
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68702-1203
Mailing Address - Country:US
Mailing Address - Phone:402-371-1360
Mailing Address - Fax:402-371-1278
Practice Address - Street 1:1502 N 13TH ST
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-2381
Practice Address - Country:US
Practice Address - Phone:402-371-1360
Practice Address - Fax:402-371-1278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025271500Medicaid