Provider Demographics
NPI:1851305841
Name:BISON DENTAL
Entity Type:Organization
Organization Name:BISON DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:JONES-WIER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:398-345-1470
Mailing Address - Street 1:PO BOX 21
Mailing Address - Street 2:912 WEST 12TH STREET
Mailing Address - City:MCCOOK
Mailing Address - State:NE
Mailing Address - Zip Code:69001-0021
Mailing Address - Country:US
Mailing Address - Phone:308-345-1470
Mailing Address - Fax:308-345-2253
Practice Address - Street 1:912 W 12TH ST
Practice Address - Street 2:
Practice Address - City:MCCOOK
Practice Address - State:NE
Practice Address - Zip Code:69001-2925
Practice Address - Country:US
Practice Address - Phone:308-345-1470
Practice Address - Fax:308-345-2253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty