Provider Demographics
NPI:1962678631
Name:ORD COSMETIC AND FAMILY DENTISTRY, P.C.
Entity Type:Organization
Organization Name:ORD COSMETIC AND FAMILY DENTISTRY, P.C.
Other - Org Name:ORD COSMETIC AND FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:S
Authorized Official - Last Name:SKOGLUND
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:402-644-3177
Mailing Address - Street 1:1626 L ST
Mailing Address - Street 2:
Mailing Address - City:ORD
Mailing Address - State:NE
Mailing Address - Zip Code:68862-1425
Mailing Address - Country:US
Mailing Address - Phone:308-728-3756
Mailing Address - Fax:
Practice Address - Street 1:1626 L ST
Practice Address - Street 2:
Practice Address - City:ORD
Practice Address - State:NE
Practice Address - Zip Code:68862-1425
Practice Address - Country:US
Practice Address - Phone:308-728-3756
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-02
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty