Organization
MPDA BROKEN BOW LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BENJAMIN ALLEN LASHLEY DDS (SOLE MEMBER)
(308) 534-1289
Entity
Organization
Contact information
Practice address
2021 SOUTH E, SUITE 5, BROKEN BOW, NE 68822
(308) 767-2004
(308) 767-2006
Mailing address
2021 SOUTH E, SUITE 5, BROKEN BOW, NE 68822
(308) 767-2004
(308) 767-2006
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
1223G0001X
General Practice Dentistry
—
—
Other
Enumeration date
01/12/2022
Last updated
01/12/2022
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