Provider Demographics
NPI:1235603184
Name:MILFORD DENTAL CLINIC
Entity Type:Organization
Organization Name:MILFORD DENTAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:
Authorized Official - Last Name:SPAHR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-761-2351
Mailing Address - Street 1:501 7TH ST
Mailing Address - Street 2:
Mailing Address - City:FAIRBURY
Mailing Address - State:NE
Mailing Address - Zip Code:68352-2309
Mailing Address - Country:US
Mailing Address - Phone:402-729-6277
Mailing Address - Fax:
Practice Address - Street 1:501 7TH ST
Practice Address - Street 2:
Practice Address - City:FAIRBURY
Practice Address - State:NE
Practice Address - Zip Code:68352-2309
Practice Address - Country:US
Practice Address - Phone:402-729-6277
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MILFORD DENTAL CLINIC, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-01-14
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE6190OtherBLUE CROSS/BLUE SHIELD