Provider Demographics
NPI:1326139155
Name:MIDLANDS ORAL HEALTH, LLC
Entity Type:Organization
Organization Name:MIDLANDS ORAL HEALTH, LLC
Other - Org Name:MIDLANDS DENTAL CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:GARVEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:712-325-1544
Mailing Address - Street 1:114 1/2 S 6TH ST
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51501-4234
Mailing Address - Country:US
Mailing Address - Phone:712-325-1544
Mailing Address - Fax:712-325-0420
Practice Address - Street 1:114 1/2 S 6TH ST
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51501-4234
Practice Address - Country:US
Practice Address - Phone:712-325-1544
Practice Address - Fax:712-325-0420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========OtherTAX ID