# MISSOURI VALLEY DENTAL GROUP, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Timber Ridge Dental Group
- **Organization subpart:** No

## Provider details

- **NPI number:** 1437467628
- **Authorized official:** JEAN ANN KERGER (CORPORATE SECRETARY)
- **Authorized official phone:** (402) 492-8300

## Contact information

- **Practice address:** 11110 FORT ST STE 106&107, OMAHA, NE 68164-2183
- **Practice address phone:** (402) 492-8300
- **Mailing address:** 11110 FORT ST STE 106&107, OMAHA, NE 68164-2183
- **Mailing address phone:** (402) 492-8300

## Taxonomy

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

## Other

- **Enumeration date:** 09/22/2010
- **Last updated:** 09/22/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 10025876100 | — | NE |