# MISSOURI VALLEY DENTAL GROUP, LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** MISSOURI VALLEY DENTAL GROUP, LLC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1407391907
- **Legal business name:** MISSOURI VALLEY DENTAL GROUP, LLC
- **Authorized official:** JEFFREY GARVEY DDS (OWNER)
- **Authorized official phone:** (712) 325-1544

## Contact information

- **Practice address:** 4620 S 25TH ST, OMAHA, NE 68107-1764
- **Practice address phone:** (402) 731-2100
- **Mailing address:** 4620 S 25TH ST, OMAHA, NE 68107-1764
- **Mailing address phone:** (402) 731-2100

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | — | — | Yes |

## Other

- **Enumeration date:** 12/20/2016
- **Last updated:** 12/20/2016