Provider Demographics
NPI:1013715531
Name:SIMPLY SMILES DENTISTRY OF COLUMBUS LLC
Entity type:Organization
Organization Name:SIMPLY SMILES DENTISTRY OF COLUMBUS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:RONKAR-HISSONG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:402-564-4408
Mailing Address - Street 1:2526 17TH ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:NE
Mailing Address - Zip Code:68601-4349
Mailing Address - Country:US
Mailing Address - Phone:402-564-4408
Mailing Address - Fax:402-564-4409
Practice Address - Street 1:2526 17TH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:NE
Practice Address - Zip Code:68601-4349
Practice Address - Country:US
Practice Address - Phone:402-564-4408
Practice Address - Fax:402-564-4409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-03
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE183135803Medicaid
NE1063515500Medicaid