NPIMap

Organization Active NPI

Pine Ridge Dental PC

  • General Practice Dentistry
  • Lincoln, NE
National Provider Identifier
1194803262
Registry record updated Nov 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
PINE RIDGE DENTAL PC
Practice address
5140 S 56TH St
Lincoln, NE 68516-1832
Phone
(402) 423-1100
NPI assigned
Nov 2, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 18, 2024

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

Authorized official

Name
Richard NolteNPI 1205094505
Title
Dentist/Owner
Phone
(402) 423-1100

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 1

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

Addresses

Primary practice location

5140 S 56TH St
Lincoln, NE 68516-1832

Mailing address

5140 S 56TH St
Lincoln, NE 68516-1832
Phone (402) 423-1100

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NE

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20241009000191 NE DME Supplier - Oral Surgery - Dentist 8729519129 Practice locations: Lincoln, NE

National Provider Directory

National Provider Directory

Locations

5140 S 56th St
Lincoln, NE 68516
Phone (402) 423-1100

Practitioners & affiliated clinicians

Practitioners 8

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": "1162425600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1731888000000",
    "number": "1194803262",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5140 S 56TH ST",
            "city": "LINCOLN",
            "state": "NE",
            "postal_code": "685161832",
            "telephone_number": "402-423-1100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5140 S 56TH ST",
            "city": "LINCOLN",
            "state": "NE",
            "postal_code": "685161832",
            "telephone_number": "402-423-1100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PINE RIDGE DENTAL PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-02",
        "last_updated": "2024-11-18",
        "certification_date": "2024-11-16",
        "status": "A",
        "authorized_official_last_name": "NOLTE",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_title_or_position": "DENTIST/OWNER",
        "authorized_official_telephone_number": "402-423-1100"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "NE",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lincoln, NE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.