Provider Demographics
NPI:1023414273
Name:PERSHING ORTHODONTICS P.C.
Entity type:Organization
Organization Name:PERSHING ORTHODONTICS P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:PERSHING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-469-5223
Mailing Address - Street 1:815 N MARIAN RD
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:NE
Mailing Address - Zip Code:68901-3489
Mailing Address - Country:US
Mailing Address - Phone:402-462-4173
Mailing Address - Fax:402-462-5516
Practice Address - Street 1:815 N MARIAN RD
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901-3489
Practice Address - Country:US
Practice Address - Phone:402-462-4173
Practice Address - Fax:402-462-5516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-17
Last Update Date:2014-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty