Provider Demographics
NPI:1508375023
Name:PEDIATRIC DENTISTRY OF NEBRASKA
Entity Type:Organization
Organization Name:PEDIATRIC DENTISTRY OF NEBRASKA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JONNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-778-7100
Mailing Address - Street 1:1439 STILLWATER AVE STE 7
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82009-7367
Mailing Address - Country:US
Mailing Address - Phone:307-778-7100
Mailing Address - Fax:
Practice Address - Street 1:820 W 42ND ST STE 1400
Practice Address - Street 2:
Practice Address - City:SCOTTSBLUFF
Practice Address - State:NE
Practice Address - Zip Code:69361-4704
Practice Address - Country:US
Practice Address - Phone:307-778-7100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-27
Last Update Date:2017-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty