Provider Demographics
NPI:1821226812
Name:DENTAL MANAGEMENT SERVICES
Entity Type:Organization
Organization Name:DENTAL MANAGEMENT SERVICES
Other - Org Name:EMERGENCY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:HAROLD
Authorized Official - Last Name:LIPPOLD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:402-593-9911
Mailing Address - Street 1:11229 W DODGE RD
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-2617
Mailing Address - Country:US
Mailing Address - Phone:402-593-9911
Mailing Address - Fax:402-593-0595
Practice Address - Street 1:11229 W DODGE RD
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-2617
Practice Address - Country:US
Practice Address - Phone:402-593-9911
Practice Address - Fax:402-593-0595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-29
Last Update Date:2009-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE5416122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0560516Medicaid