Provider Demographics
NPI:1669179651
Name:TODAY'S DENTAL BELLEVUE, LLC
Entity type:Organization
Organization Name:TODAY'S DENTAL BELLEVUE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:J
Authorized Official - Last Name:RISING
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:701-799-6453
Mailing Address - Street 1:27330 W CENTER RD
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:NE
Mailing Address - Zip Code:68069-6814
Mailing Address - Country:US
Mailing Address - Phone:701-361-4560
Mailing Address - Fax:
Practice Address - Street 1:2207 LONGO DRIVE
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68005
Practice Address - Country:US
Practice Address - Phone:701-799-6453
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-10
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty