Provider Demographics
NPI:1225483290
Name:FAMILY FIRST DENTAL ASSOCIATES OF COLUMBUS, PC
Entity Type:Organization
Organization Name:FAMILY FIRST DENTAL ASSOCIATES OF COLUMBUS, PC
Other - Org Name:FAMILY 1ST DENTAL OF COLUMBUS WEST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGIONAL COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:NADINE
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:PROSOSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-640-9329
Mailing Address - Street 1:3611 27TH ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:NE
Mailing Address - Zip Code:68601-2397
Mailing Address - Country:US
Mailing Address - Phone:402-564-7575
Mailing Address - Fax:402-564-1818
Practice Address - Street 1:3611 27TH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:NE
Practice Address - Zip Code:68601-2397
Practice Address - Country:US
Practice Address - Phone:402-564-7575
Practice Address - Fax:402-564-1818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-27
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty