NPIMap

Organization Active NPI

Missouri Valley Dental Group, LLC

  • General Practice Dentistry
  • Omaha, NE
National Provider Identifier
1437467628
Registry record updated Sep 22, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
MISSOURI VALLEY DENTAL GROUP, LLC
Practice address
11110 Fort St Ste 106&107
Omaha, NE 68164-2183
Phone
(402) 492-8300
NPI assigned
Sep 22, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 22, 2010

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

Authorized official

Name
Jean Ann Kerger
Title
Corporate Secretary
Phone
(402) 492-8300

Specialties & licenses 1

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

Addresses

Primary practice location

11110 Fort St Ste 106&107
Omaha, NE 68164-2183

Mailing address

11110 Fort St Ste 106&107
Omaha, NE 68164-2183
Phone (402) 492-8300

Other identifiers 1

IdentifierTypeStateIssuer
10025876100MedicaidNE

Other names 1

  • Timber Ridge Dental Group Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Missouri Valley Dental Group LLC5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Locations

11110 Fort St
Ste 106107
Omaha, NE 68164
Phone (402) 492-8300

Ownership & related parties

Subparts reporting this organization as parent 2

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

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": "1285113600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1285113600000",
    "number": "1437467628",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11110 FORT ST STE 106&107",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681642183",
            "telephone_number": "402-492-8300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11110 FORT ST STE 106&107",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681642183",
            "telephone_number": "402-492-8300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MISSOURI VALLEY DENTAL GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-09-22",
        "last_updated": "2010-09-22",
        "status": "A",
        "authorized_official_last_name": "KERGER",
        "authorized_official_first_name": "JEAN",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "CORPORATE SECRETARY",
        "authorized_official_telephone_number": "402-492-8300"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10025876100",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Timber Ridge Dental Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Omaha, NE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2010; 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.