Provider Demographics
NPI:1932416278
Name:DENTAL BASICS PC
Entity Type:Organization
Organization Name:DENTAL BASICS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HAL
Authorized Official - Middle Name:T
Authorized Official - Last Name:RITCHIE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:402-384-8414
Mailing Address - Street 1:920 S 107TH AVE STE 106
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-4719
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:920 S 107TH AVE STE 106
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-4719
Practice Address - Country:US
Practice Address - Phone:402-384-8414
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-08
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025200700Medicaid