NPIMap

Organization Active NPI

Siouxland Dental Health - South Sioux, LLC

  • General Practice Dentistry
  • South Sioux City, NE
National Provider Identifier
1386981561
Registry record updated Jan 9, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
SIOUXLAND DENTAL HEALTH - SOUTH SIOUX, LLC
Practice address
2600 Cornhusker Dr
South Sioux City, NE 68776-3905
Phone
(402) 494-2692
Fax
(402) 494-2701
NPI assigned
Jan 9, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 9, 2013

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

Authorized official

Name
Ronel McCombs
Title
Credentialing Specialist
Phone
(502) 254-8500

Specialties & licenses 1

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

Addresses

Primary practice location

2600 Cornhusker Dr
South Sioux City, NE 68776-3905

Mailing address

PO Box 437169
Louisville, KY 40253-7169
Phone (502) 254-8500

National Provider Directory

National Provider Directory

Locations

2600 Cornhusker Dr
South Sioux City, NE 68776
Phone (402) 494-2692

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": "1357689600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1357689600000",
    "number": "1386981561",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 437169",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402537169",
            "telephone_number": "502-254-8500",
            "fax_number": "502-245-5021"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2600 CORNHUSKER DR",
            "city": "SOUTH SIOUX CITY",
            "state": "NE",
            "postal_code": "687763905",
            "telephone_number": "402-494-2692",
            "fax_number": "402-494-2701"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SIOUXLAND DENTAL HEALTH - SOUTH SIOUX, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-01-09",
        "last_updated": "2013-01-09",
        "status": "A",
        "authorized_official_last_name": "MCCOMBS",
        "authorized_official_first_name": "RONEL",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "502-254-8500"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in South Sioux City, NE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2013; 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.