Provider Demographics
NPI:1750367728
Name:LOFGREEN, DAVID (DDS)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:LOFGREEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:638 N WEBB RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68803-4049
Mailing Address - Country:US
Mailing Address - Phone:308-381-0167
Mailing Address - Fax:308-381-6689
Practice Address - Street 1:638 N WEBB RD
Practice Address - Street 2:SUITE 1
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-4049
Practice Address - Country:US
Practice Address - Phone:308-381-0167
Practice Address - Fax:308-381-6689
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE42581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47059758613Medicaid
NE4764OtherBC/BS PROVIDER #