Provider Demographics
NPI:1295007235
Name:FAMILY FIRST DENTAL ASSOCIATES OF NEBRASKA, PC
Entity Type:Organization
Organization Name:FAMILY FIRST DENTAL ASSOCIATES OF NEBRASKA, PC
Other - Org Name:FAMILY FIRST DENTAL OF NORFOLK TAYLOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:S
Authorized Official - Last Name:SKOGLUND
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:402-644-3177
Mailing Address - Street 1:2104 TAYLOR AVE.
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701-3283
Mailing Address - Country:US
Mailing Address - Phone:402-371-6566
Mailing Address - Fax:
Practice Address - Street 1:2104 TAYLOR AVE
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-4640
Practice Address - Country:US
Practice Address - Phone:402-371-6566
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-07
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE49611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty