Provider Demographics
NPI:1669834693
Name:GREAT PLAINS DENTAL SPECIALISTS, PC
Entity Type:Organization
Organization Name:GREAT PLAINS DENTAL SPECIALISTS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:CLINE
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:402-330-4100
Mailing Address - Street 1:615 N 90TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-2821
Mailing Address - Country:US
Mailing Address - Phone:402-330-4100
Mailing Address - Fax:402-330-4103
Practice Address - Street 1:615 N 90TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-2821
Practice Address - Country:US
Practice Address - Phone:402-330-4100
Practice Address - Fax:402-330-4103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-29
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty