Provider Demographics
NPI:1649581653
Name:CHURCHILL, JOSEPH FLAHERTY (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:FLAHERTY
Last Name:CHURCHILL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 INDIAN HILLS DR
Mailing Address - Street 2:CARL T. CURTIS HEALTH EDUCATION CENTER DENTAL CLINIC
Mailing Address - City:MACY
Mailing Address - State:NE
Mailing Address - Zip Code:68039-3023
Mailing Address - Country:US
Mailing Address - Phone:402-837-5381
Mailing Address - Fax:
Practice Address - Street 1:100 INDIAN HILLS DR
Practice Address - Street 2:CARL T. CURTIS HEALTH EDUCATION CENTER DENTAL CLINIC
Practice Address - City:MACY
Practice Address - State:NE
Practice Address - Zip Code:68039-3023
Practice Address - Country:US
Practice Address - Phone:402-837-5381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-24
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0102251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice