Provider Demographics
NPI:1487670774
Name:CENTRAL COMMUNITY COLLEGE DENTAL HYGIENE CLINIC
Entity Type:Organization
Organization Name:CENTRAL COMMUNITY COLLEGE DENTAL HYGIENE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTAL HYGIENE PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:CLOET
Authorized Official - Suffix:
Authorized Official - Credentials:RDH, MS
Authorized Official - Phone:402-461-2470
Mailing Address - Street 1:3325 E. COMMUNITY DRIVE
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:NE
Mailing Address - Zip Code:68902-1024
Mailing Address - Country:US
Mailing Address - Phone:402-461-2468
Mailing Address - Fax:402-460-2128
Practice Address - Street 1:3325 E. COMMUNITY DRIVE
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68902-1024
Practice Address - Country:US
Practice Address - Phone:402-461-2468
Practice Address - Fax:402-460-2128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========-13Medicaid