Organization
SHADOW RIDGE DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES W BECKER DDS (OWNER)
(402) 933-0525
Entity
Organization
Contact information
Practice address
19103 MASON PLZ, ELKHORN, NE 68022-5659
(402) 933-0525
(402) 933-2925
Mailing address
19103 MASON PLZ, ELKHORN, NE 68022-5659
(402) 933-0525
(402) 933-2925
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
4488
NE
1223G0001X
General Practice Dentistry
Primary
4791
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100251659-00
—
NE
Enumeration date
02/28/2011
Last updated
02/28/2011
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