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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