NPIMap

Organization Active NPI

Mpda Broken Bow LLC

  • Dentist
  • Broken Bow, NE
National Provider Identifier
1376294298
Registry record updated Jan 12, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
MPDA BROKEN BOW LLC
Practice address
2021 South E
Suite 5
Broken Bow, NE 68822
Phone
(308) 767-2004
Fax
(308) 767-2006
NPI assigned
Jan 12, 2022
Last updated
Jan 12, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 12, 2022

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

Authorized official

Name
Benjamin Allen Lashley, DDSNPI 1619993862
Title
Sole Member
Phone
(308) 534-1289

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X NU Primary
General Practice Dentistry 1223G0001X NU

Addresses

Primary practice location

2021 South E
Suite 5
Broken Bow, NE 68822

Mailing address

2021 South E
Suite 5
Broken Bow, NE 68822
Phone (308) 767-2004

National Provider Directory

National Provider Directory

Locations

2021 S E St
Ste 5
Broken Bow, NE 68822
Phone (308) 767-2004

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1641945600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1641945600000",
    "number": "1376294298",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2021 SOUTH E",
            "address_2": "SUITE 5",
            "city": "BROKEN BOW",
            "state": "NE",
            "postal_code": "68822",
            "telephone_number": "308-767-2004",
            "fax_number": "308-767-2006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2021 SOUTH E",
            "address_2": "SUITE 5",
            "city": "BROKEN BOW",
            "state": "NE",
            "postal_code": "68822",
            "telephone_number": "308-767-2004",
            "fax_number": "308-767-2006"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MPDA BROKEN BOW LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-01-12",
        "last_updated": "2022-01-12",
        "certification_date": "2022-01-12",
        "status": "A",
        "authorized_official_last_name": "LASHLEY",
        "authorized_official_first_name": "BENJAMIN",
        "authorized_official_middle_name": "ALLEN",
        "authorized_official_title_or_position": "SOLE MEMBER",
        "authorized_official_telephone_number": "308-534-1289",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Broken Bow, NE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2022; 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.