Provider Demographics
NPI:1932477882
Name:LIFESMILES OF SIDNEY
Entity Type:Organization
Organization Name:LIFESMILES OF SIDNEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEASA
Authorized Official - Middle Name:
Authorized Official - Last Name:DORNBIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:308-249-1810
Mailing Address - Street 1:1040 OLD POST RD
Mailing Address - Street 2:
Mailing Address - City:SIDNEY
Mailing Address - State:NE
Mailing Address - Zip Code:69162-3065
Mailing Address - Country:US
Mailing Address - Phone:308-254-7171
Mailing Address - Fax:308-254-7172
Practice Address - Street 1:1040 OLD POST RD
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:NE
Practice Address - Zip Code:69162-3065
Practice Address - Country:US
Practice Address - Phone:308-254-7171
Practice Address - Fax:308-254-7172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-07
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE66831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty