# KERSENBROCK DENTAL CARE LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1083973671
- **Authorized official:** DR. MAURICE JOHN KERSENBROCK DDS (PRESIDENT)
- **Authorized official phone:** (402) 336-4211

## Contact information

- **Practice address:** 430 E. EVERETT ST., O'NEILL, NE 68763-1838
- **Practice address phone:** (402) 336-4211
- **Practice address fax:** (402) 336-3905
- **Mailing address:** PO BOX 189, O'NEILL, NE 68763-0189
- **Mailing address phone:** (402) 336-4211
- **Mailing address fax:** (402) 336-3905

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 4971 | NE | Yes |
| 1223G0001X | General Practice Dentistry | 6903 | NE | — |

## Other

- **Enumeration date:** 05/16/2012
- **Last updated:** 06/25/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 10025832300 | — | NE |