Provider Demographics
NPI:1811583693
Name:ENCOMPASS DENTAL STUDIOS, LLC
Entity Type:Organization
Organization Name:ENCOMPASS DENTAL STUDIOS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/ MAJORITY OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:ALEXANDER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:402-276-2980
Mailing Address - Street 1:4825 37TH ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:NE
Mailing Address - Zip Code:68601-1525
Mailing Address - Country:US
Mailing Address - Phone:402-276-2980
Mailing Address - Fax:
Practice Address - Street 1:3024 25TH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:NE
Practice Address - Zip Code:68601-2404
Practice Address - Country:US
Practice Address - Phone:402-563-4565
Practice Address - Fax:402-563-4566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-16
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026852600Medicaid