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Organization
MISSOURI VALLEY DENTAL GROUP, LLC
Active
Organization
MISSOURI VALLEY DENTAL GROUP, LLC
Active
Other names
Timber Ridge Dental Group
Organization subpart
No
Provider details
NPI number
Authorized official
JEAN ANN KERGER (CORPORATE SECRETARY)
(402) 492-8300
Entity
Organization
Contact information
Practice address
11110 FORT ST STE 106&107, OMAHA, NE 68164-2183
(402) 492-8300
Mailing address
11110 FORT ST STE 106&107, OMAHA, NE 68164-2183
(402) 492-8300
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10025876100
—
NE
Enumeration date
09/22/2010
Last updated
09/22/2010
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