Provider Demographics
NPI:1376222786
Name:JOHNDREAU DENTAL LLC
Entity Type:Organization
Organization Name:JOHNDREAU DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNDREAU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:402-309-3033
Mailing Address - Street 1:PO BOX 71
Mailing Address - Street 2:
Mailing Address - City:CHADRON
Mailing Address - State:NE
Mailing Address - Zip Code:69337-0071
Mailing Address - Country:US
Mailing Address - Phone:308-432-5626
Mailing Address - Fax:
Practice Address - Street 1:805 PINECREST DR
Practice Address - Street 2:
Practice Address - City:CHADRON
Practice Address - State:NE
Practice Address - Zip Code:69337-2845
Practice Address - Country:US
Practice Address - Phone:308-432-5626
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-13
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty