Provider Demographics
NPI:1275778227
Name:HOLDREGE FAMILY DENTAL, L.L.C
Entity Type:Organization
Organization Name:HOLDREGE FAMILY DENTAL, L.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:NELSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:308-995-8666
Mailing Address - Street 1:PO BOX 408
Mailing Address - Street 2:
Mailing Address - City:HOLDREGE
Mailing Address - State:NE
Mailing Address - Zip Code:68949-0408
Mailing Address - Country:US
Mailing Address - Phone:308-995-8666
Mailing Address - Fax:308-995-2759
Practice Address - Street 1:130 W 14TH AVE
Practice Address - Street 2:
Practice Address - City:HOLDREGE
Practice Address - State:NE
Practice Address - Zip Code:68949-1270
Practice Address - Country:US
Practice Address - Phone:308-995-8666
Practice Address - Fax:308-995-2759
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-04
Last Update Date:2014-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty