Provider Demographics
NPI:1558428003
Name:MIDLANDS DENTAL GROUP LLC
Entity Type:Organization
Organization Name:MIDLANDS DENTAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:KERGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-642-4136
Mailing Address - Street 1:712 FORT CROOK RD N
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68005-4558
Mailing Address - Country:US
Mailing Address - Phone:402-733-6066
Mailing Address - Fax:402-733-0899
Practice Address - Street 1:712 FORT CROOK RD N
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68005-4558
Practice Address - Country:US
Practice Address - Phone:402-733-6066
Practice Address - Fax:402-733-0899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty