# MAPLE PARK DENTAL ASSOCIATES PC

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

## Provider details

- **NPI number:** 1902059397
- **Authorized official:** LIBBY ANN LASHLEY (CLINIC COORDINATOR)
- **Authorized official phone:** (308) 534-1289

## Contact information

- **Practice address:** 805 S MAPLE ST, NORTH PLATTE, NE 69101-5282
- **Practice address phone:** (308) 534-1289
- **Mailing address:** PO BOX 1518, 805 S. MAPLE ST., NORTH PLATTE, NE 69103-1518
- **Mailing address phone:** (308) 534-1289

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 4669 | NE | — |
| 1223G0001X | General Practice Dentistry | 6094 | NE | — |
| 1223G0001X | General Practice Dentistry | 6207 | NE | Yes |

## Other

- **Enumeration date:** 10/29/2008
- **Last updated:** 10/29/2008