Provider Demographics
NPI:1053094177
Name:YOUR FAMILY DENTIST P.C.
Entity type:Organization
Organization Name:YOUR FAMILY DENTIST P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:JESSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-339-2501
Mailing Address - Street 1:10274 S 71ST ST
Mailing Address - Street 2:
Mailing Address - City:PAPILLION
Mailing Address - State:NE
Mailing Address - Zip Code:68133-2659
Mailing Address - Country:US
Mailing Address - Phone:402-339-2501
Mailing Address - Fax:402-339-2503
Practice Address - Street 1:10274 S 71ST ST
Practice Address - Street 2:
Practice Address - City:PAPILLION
Practice Address - State:NE
Practice Address - Zip Code:68133-2659
Practice Address - Country:US
Practice Address - Phone:402-339-2501
Practice Address - Fax:402-339-2503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-08
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty