Provider Demographics
NPI:1326764333
Name:REM DDS, LLC
Entity Type:Organization
Organization Name:REM DDS, LLC
Other - Org Name:EMERGENCY DENTAL OF GRAND RAPIDS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RIKKI
Authorized Official - Middle Name:
Authorized Official - Last Name:LIEBERTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-505-6843
Mailing Address - Street 1:6606 S 168TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68135-5420
Mailing Address - Country:US
Mailing Address - Phone:402-505-6843
Mailing Address - Fax:
Practice Address - Street 1:847 PARCHMENT DR SE STE 110
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-2377
Practice Address - Country:US
Practice Address - Phone:616-856-4911
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REM DDS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-10-12
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental