Provider Demographics
NPI:1457695959
Name:SOUTHPOINTE DENTAL
Entity Type:Organization
Organization Name:SOUTHPOINTE DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:
Authorized Official - Last Name:ALDERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:402-423-3333
Mailing Address - Street 1:7940 S. 13TH ST.
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68512-9618
Mailing Address - Country:US
Mailing Address - Phone:402-423-3333
Mailing Address - Fax:402-423-3334
Practice Address - Street 1:7940 S. 13TH ST.
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68512-9618
Practice Address - Country:US
Practice Address - Phone:402-423-3333
Practice Address - Fax:402-423-3334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-21
Last Update Date:2012-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025917500Medicaid