Provider Demographics
NPI:1871889279
Name:GREAT PLAINS DENTAL ASSOCIATES, LLP
Entity type:Organization
Organization Name:GREAT PLAINS DENTAL ASSOCIATES, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JANIS
Authorized Official - Middle Name:J
Authorized Official - Last Name:APPLEGATE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:308-236-7306
Mailing Address - Street 1:4701 1ST AVENUE PL
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68847-8355
Mailing Address - Country:US
Mailing Address - Phone:308-236-7306
Mailing Address - Fax:
Practice Address - Street 1:4701 1ST AVENUE PL
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68847-8355
Practice Address - Country:US
Practice Address - Phone:308-236-7306
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-23
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE50471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty