Provider Demographics
NPI:1316368384
Name:FAMILY FIRST DENTALASSOCCIATES OF WEST POINT, P.C.
Entity Type:Organization
Organization Name:FAMILY FIRST DENTALASSOCCIATES OF WEST POINT, P.C.
Other - Org Name:FAMILY FIRST DENTAL OF FREMONT -2
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:
Authorized Official - Phone:402-644-3177
Mailing Address - Street 1:140 E 22ND ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:FREMONT
Mailing Address - State:NE
Mailing Address - Zip Code:68025-2667
Mailing Address - Country:US
Mailing Address - Phone:402-727-9525
Mailing Address - Fax:
Practice Address - Street 1:140 E 22ND ST
Practice Address - Street 2:STE 2
Practice Address - City:FREMONT
Practice Address - State:NE
Practice Address - Zip Code:68025-2667
Practice Address - Country:US
Practice Address - Phone:402-727-9525
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-18
Last Update Date:2013-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty