Provider Demographics
NPI:1720854540
Name:UPTOWN DDS LLC
Entity Type:Organization
Organization Name:UPTOWN DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:KAUS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:623-262-4878
Mailing Address - Street 1:4830 SAINT PAUL AVE
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68504-2661
Mailing Address - Country:US
Mailing Address - Phone:402-466-2211
Mailing Address - Fax:
Practice Address - Street 1:4830 SAINT PAUL AVE
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68504-2661
Practice Address - Country:US
Practice Address - Phone:402-466-2211
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-01
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental