| Southroads Dental &/or Dream Dental Care | |
|
712 Fort Crook Rd N Bellevue NE 68005-4558 | |
| (402) 733-6066 | |
| (402) 733-0899 |
| Full Name | Southroads Dental &/or Dream Dental Care |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 712 Fort Crook Rd N, Bellevue, Nebraska |
| Authorized Official Name and Position | Robert Frazier Colwell (PRESIDENT/OWNER) |
| Authorized Official Contact | 4027336066 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Southroads Dental &/or Dream Dental Care 712 Fort Crook Rd N Bellevue NE 68005-4558 Ph: (402) 733-6066 | Southroads Dental &/or Dream Dental Care 712 Fort Crook Rd N Bellevue NE 68005-4558 Ph: (402) 733-6066 |
| NPI Number | 1629354667 |
|---|---|
| Provider Enumeration Date | 10/21/2011 |
| Last Update Date | 01/23/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629354667 | NPI | - | NPPES |
| 10025204800 | Medicaid | NE | |
| 15558428003 | Medicaid | IA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 6236 (Nebraska) | Primary |
| 261QD0000X | Clinic/center - Dental | 8073 (Iowa) | Secondary |
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› Verified 6 days ago
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