Provider Demographics
NPI:1629601075
Name:PLATTSMOUTH DENTAL
Entity Type:Organization
Organization Name:PLATTSMOUTH DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRITTANY
Authorized Official - Middle Name:
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-991-9423
Mailing Address - Street 1:619 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PLATTSMOUTH
Mailing Address - State:NE
Mailing Address - Zip Code:68048-1853
Mailing Address - Country:US
Mailing Address - Phone:402-296-2188
Mailing Address - Fax:402-296-4480
Practice Address - Street 1:619 MAIN ST
Practice Address - Street 2:
Practice Address - City:PLATTSMOUTH
Practice Address - State:NE
Practice Address - Zip Code:68048-1853
Practice Address - Country:US
Practice Address - Phone:402-296-2188
Practice Address - Fax:402-296-4480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-13
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty