Provider Demographics
NPI:1578852083
Name:FLP, LLC
Entity Type:Organization
Organization Name:FLP, LLC
Other - Org Name:DELIVERED DENTAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF ADMINISTRASTION
Authorized Official - Prefix:MS
Authorized Official - First Name:KELLEY
Authorized Official - Middle Name:A
Authorized Official - Last Name:BARNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-917-8193
Mailing Address - Street 1:7930 DREXEL ST.
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68127
Mailing Address - Country:US
Mailing Address - Phone:402-917-8193
Mailing Address - Fax:402-691-0251
Practice Address - Street 1:7930 DREXEL ST.
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68127
Practice Address - Country:US
Practice Address - Phone:402-917-8193
Practice Address - Fax:402-691-0251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-05
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE5109122300000X
NE6701122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025607500Medicaid