Provider Demographics
NPI:1982855474
Name:SEWARD DENTAL CLINIC LLC
Entity Type:Organization
Organization Name:SEWARD DENTAL CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:MINCHOW
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:402-643-2931
Mailing Address - Street 1:306 S 4TH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SEWARD
Mailing Address - State:NE
Mailing Address - Zip Code:68434
Mailing Address - Country:US
Mailing Address - Phone:402-643-2931
Mailing Address - Fax:
Practice Address - Street 1:306 S 4TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:SEWARD
Practice Address - State:NE
Practice Address - Zip Code:68434
Practice Address - Country:US
Practice Address - Phone:402-643-2931
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-02
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE64761223G0001X
NE59181223G0001X
NE44591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========13Medicaid