Provider Demographics
NPI:1013645738
Name:UPLIFT FAMILY DENTISTRY LLC
Entity Type:Organization
Organization Name:UPLIFT FAMILY DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:KUCIREK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:712-623-5404
Mailing Address - Street 1:101 NORTHWEST RD
Mailing Address - Street 2:
Mailing Address - City:IMOGENE
Mailing Address - State:IA
Mailing Address - Zip Code:51645-4047
Mailing Address - Country:US
Mailing Address - Phone:402-881-9378
Mailing Address - Fax:
Practice Address - Street 1:1700 E SUMMIT ST
Practice Address - Street 2:
Practice Address - City:RED OAK
Practice Address - State:IA
Practice Address - Zip Code:51566-1711
Practice Address - Country:US
Practice Address - Phone:712-623-5404
Practice Address - Fax:712-623-5231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-10
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty