Provider Demographics
NPI:1952021537
Name:MIDWEST ENDODONTICS, LLC
Entity Type:Organization
Organization Name:MIDWEST ENDODONTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOPPE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-398-9887
Mailing Address - Street 1:13500 CALIFORNIA ST STE 220
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-5248
Mailing Address - Country:US
Mailing Address - Phone:402-398-9887
Mailing Address - Fax:
Practice Address - Street 1:13500 CALIFORNIA ST STE 220
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-5248
Practice Address - Country:US
Practice Address - Phone:402-398-9887
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-01
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty