Provider Demographics
NPI:1053093583
Name:EDGEWOOD DENTAL GROUP
Entity type:Organization
Organization Name:EDGEWOOD DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS
Authorized Official - Prefix:
Authorized Official - First Name:SHARLENE
Authorized Official - Middle Name:A
Authorized Official - Last Name:HOCK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:402-423-2900
Mailing Address - Street 1:5310 S 56TH ST STE 3
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-1892
Mailing Address - Country:US
Mailing Address - Phone:402-423-2900
Mailing Address - Fax:402-423-2907
Practice Address - Street 1:5310 S 56TH ST STE 3
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-1892
Practice Address - Country:US
Practice Address - Phone:402-423-2900
Practice Address - Fax:402-423-2907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-03
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental