Provider Demographics
NPI:1871028159
Name:COMPLETE FAMILY DENTISTRY
Entity Type:Organization
Organization Name:COMPLETE FAMILY DENTISTRY
Other - Org Name:ALIGN DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:FARRAH
Authorized Official - Middle Name:
Authorized Official - Last Name:PLATE
Authorized Official - Suffix:
Authorized Official - Credentials:DR
Authorized Official - Phone:402-499-0624
Mailing Address - Street 1:9635 KOI ROCK DR
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68526-9678
Mailing Address - Country:US
Mailing Address - Phone:402-499-0624
Mailing Address - Fax:
Practice Address - Street 1:9635 KOI ROCK DR
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68526-9678
Practice Address - Country:US
Practice Address - Phone:402-499-0624
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-25
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE6546122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025400000Medicaid