Provider Demographics
NPI:1184500241
Name:FULL CIRCLE DENTAL
Entity type:Organization
Organization Name:FULL CIRCLE DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALIVIA
Authorized Official - Middle Name:GRACE
Authorized Official - Last Name:FOCKEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:308-440-1540
Mailing Address - Street 1:102 W SENECA ST
Mailing Address - Street 2:
Mailing Address - City:RAVENNA
Mailing Address - State:NE
Mailing Address - Zip Code:68869-1363
Mailing Address - Country:US
Mailing Address - Phone:308-455-7069
Mailing Address - Fax:
Practice Address - Street 1:102 W SENECA ST
Practice Address - Street 2:
Practice Address - City:RAVENNA
Practice Address - State:NE
Practice Address - Zip Code:68869-1363
Practice Address - Country:US
Practice Address - Phone:308-455-7069
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-14
Last Update Date:2025-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental