Provider Demographics
NPI:1811088693
Name:HILLSBOROUGH FAMILY DENTISTRY, P.C.
Entity type:Organization
Organization Name:HILLSBOROUGH FAMILY DENTISTRY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:SAMUELSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:402-445-4647
Mailing Address - Street 1:13808 W MAPLE RD
Mailing Address - Street 2:SUITE 112
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68164-6231
Mailing Address - Country:US
Mailing Address - Phone:402-445-4647
Mailing Address - Fax:402-445-8370
Practice Address - Street 1:13808 W MAPLE RD
Practice Address - Street 2:SUITE 112
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68164-6231
Practice Address - Country:US
Practice Address - Phone:402-445-4647
Practice Address - Fax:402-445-8370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE60781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty