NPIMap

Organization Active NPI

Sedillo Mobile DDS NE LLC

  • Dental Clinic/Center
  • Fort Calhoun, NE
National Provider Identifier
1366213258
Registry record updated Jan 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
Legal business name
SEDILLO MOBILE DDS NE LLC
Practice address
5884 High Pasture Dr
Fort Calhoun, NE 68023-8201
Phone
(402) 237-2163
NPI assigned
Jan 10, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 10, 2024

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

Authorized official

Name
Jessica Ann Olivares
Title
Office Manager
Phone
(712) 326-4860

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X Primary

Addresses

Primary practice location

5884 High Pasture Dr
Fort Calhoun, NE 68023-8201

Mailing address

5884 High Pasture Dr
Fort Calhoun, NE 68023-8201
Phone (402) 237-2163

Other names 1

  • Dignity Dental Other name

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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": "1704844800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704844800000",
    "number": "1366213258",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5884 HIGH PASTURE DR",
            "city": "FORT CALHOUN",
            "state": "NE",
            "postal_code": "680238201",
            "telephone_number": "402-237-2163"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5884 HIGH PASTURE DR",
            "city": "FORT CALHOUN",
            "state": "NE",
            "postal_code": "680238201",
            "telephone_number": "402-237-2163"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SEDILLO MOBILE DDS NE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-01-10",
        "last_updated": "2024-01-10",
        "certification_date": "2024-01-10",
        "status": "A",
        "authorized_official_last_name": "OLIVARES",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "712-326-4860"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dignity Dental",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Fort Calhoun, NE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2024; 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.