| Mpda Broken Bow LLC | |
|
2021 South E Suite 5 Broken Bow NE 68822 | |
| (308) 767-2004 | |
| (308) 767-2006 |
| Full Name | Mpda Broken Bow LLC |
|---|---|
| Speciality | Dentist |
| Location | 2021 South E, Broken Bow, Nebraska |
| Authorized Official Name and Position | Benjamin Allen Lashley (SOLE MEMBER) |
| Authorized Official Contact | 3085341289 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mpda Broken Bow LLC 2021 South E Suite 5 Broken Bow NE 68822 Ph: (308) 767-2004 | Mpda Broken Bow LLC 2021 South E Suite 5 Broken Bow NE 68822 Ph: (308) 767-2004 |
| NPI Number | 1376294298 |
|---|---|
| Provider Enumeration Date | 01/12/2022 |
| Last Update Date | 01/12/2022 |
| Certification Date | 01/12/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376294298 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | () | Primary |
| 1223G0001X | Dentist - General Practice | () | Secondary |
Broken Bow Dental Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 551 S E St, Broken Bow, NE 68822 Phone: 308-293-0291 |