NPIMap

Organization Active NPI

Kersenbrock Dental Care LLC

  • General Practice Dentistry
  • O'Neill, NE
National Provider Identifier
1083973671
Registry record updated Jun 25, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
4971 Issued in NE
Legal business name
KERSENBROCK DENTAL CARE LLC
Practice address
430 E. Everett St.
O'Neill, NE 68763-1838
Phone
(402) 336-4211
Fax
(402) 336-3905
NPI assigned
May 16, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 25, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Maurice John Kersenbrock, DDSNPI 1588653356
Title
President
Phone
(402) 336-4211

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X 4971 NE Primary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X 6903 NE

Addresses

Primary practice location

430 E. Everett St.
O'Neill, NE 68763-1838

Mailing address

PO Box 189
O'Neill, NE 68763-0189
Phone (402) 336-4211

Other identifiers 1

IdentifierTypeStateIssuer
10025832300MedicaidNE

National Provider Directory

National Provider Directory

Locations

430 E Everett St
Oneill, NE 68763
Phone (402) 336-4211

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1337126400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1340582400000",
    "number": "1083973671",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 189",
            "city": "O'NEILL",
            "state": "NE",
            "postal_code": "687630189",
            "telephone_number": "402-336-4211",
            "fax_number": "402-336-3905"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "430 E. EVERETT ST.",
            "city": "O'NEILL",
            "state": "NE",
            "postal_code": "687631838",
            "telephone_number": "402-336-4211",
            "fax_number": "402-336-3905"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KERSENBROCK DENTAL CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-16",
        "last_updated": "2012-06-25",
        "status": "A",
        "authorized_official_last_name": "KERSENBROCK",
        "authorized_official_first_name": "MAURICE",
        "authorized_official_middle_name": "JOHN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "402-336-4211",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "NE",
            "license": "4971",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "NE",
            "license": "6903",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10025832300",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in O'Neill, NE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.