Provider Demographics
NPI:1750734190
Name:FALLBROOK FAMILY DENTISTRY
Entity type:Organization
Organization Name:FALLBROOK FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ALYSSA
Authorized Official - Middle Name:
Authorized Official - Last Name:CATTLE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:402-467-0007
Mailing Address - Street 1:575 FALLBROOK BLVD
Mailing Address - Street 2:SUITE #107
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68521-9039
Mailing Address - Country:US
Mailing Address - Phone:402-467-0007
Mailing Address - Fax:
Practice Address - Street 1:575 FALLBROOK BLVD
Practice Address - Street 2:SUITE #107
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68521-9039
Practice Address - Country:US
Practice Address - Phone:402-467-0007
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MILFORD DENTAL CLINIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-07-21
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE7324122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty