Provider Demographics
NPI:1316581481
Name:OFD13, LLC
Entity Type:Organization
Organization Name:OFD13, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:NICHOLAS
Authorized Official - Last Name:VONDRAK
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:402-212-5131
Mailing Address - Street 1:PO BOX 45856
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68145-0856
Mailing Address - Country:US
Mailing Address - Phone:402-779-5334
Mailing Address - Fax:
Practice Address - Street 1:2837 W NORTHERN AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85051-6646
Practice Address - Country:US
Practice Address - Phone:602-622-9653
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-01
Last Update Date:2019-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty