| Mobile Dental Care Of Nebraska Llc | |
|
2525 S 135th Ave Omaha NE 68144-2424 | |
| (502) 244-2441 | |
| (502) 254-4069 |
| Full Name | Mobile Dental Care Of Nebraska Llc |
|---|---|
| Speciality | Dentist |
| Location | 2525 S 135th Ave, Omaha, Nebraska |
| Authorized Official Name and Position | Delia Ritter (CREDENTIALING MANAGER) |
| Authorized Official Contact | 5022442441 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mobile Dental Care Of Nebraska Llc 12910 Shelbyville Rd Ste 300 Louisville KY 40243-2404 Ph: (502) 244-2441 | Mobile Dental Care Of Nebraska Llc 2525 S 135th Ave Omaha NE 68144-2424 Ph: (502) 244-2441 |
| NPI Number | 1144621996 |
|---|---|
| Provider Enumeration Date | 09/11/2014 |
| Last Update Date | 02/02/2017 |
| Medicare PECOS PAC ID | 2264717586 |
|---|---|
| Medicare Enrollment ID | O20170328001317 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144621996 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Primary |
| 124Q00000X | Dental Hygienist | (* (Not Available)) | Secondary |
| Provider Name | Kris M Pollock |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1346315777 PECOS PAC ID: 8325323645 Enrollment ID: I20170328001311 |
| Provider Name | Wesley Parks |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1508828997 PECOS PAC ID: 5092090175 Enrollment ID: I20170403001376 |
| Provider Name | Rachel L Brown |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1710244439 PECOS PAC ID: 5799005450 Enrollment ID: I20170405000958 |
| Provider Name | Lonnie Ray Flagtwet |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1598784472 PECOS PAC ID: 7911201801 Enrollment ID: I20170406000442 |
| Provider Name | Joseph Hartnett |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1306295910 PECOS PAC ID: 5092082099 Enrollment ID: I20170523001135 |
| Provider Name | Clyde D Knoblauch |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1972666758 PECOS PAC ID: 2365716446 Enrollment ID: I20170928001738 |
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