NPIMap

Organization Active NPI

Waterford Dental, LLC

  • General Practice Dentistry
  • Bennington, NE
National Provider Identifier
1962125492
Registry record updated Sep 20, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
WATERFORD DENTAL, LLC
Practice address
15450 Ida Street
Suite 100
Bennington, NE 68007
Phone
(701) 799-6453
NPI assigned
Sep 20, 2022
Last updated
Sep 20, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 20, 2022

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

Authorized official

Name
Brent Rising, DDSNPI 1558598961
Title
Owner
Phone
(701) 799-6453

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X Primary

Addresses

Primary practice location

15450 Ida Street
Suite 100
Bennington, NE 68007

Mailing address

27330 W Center Rd
Waterloo, NE 68069-6814
Phone (701) 799-6453

National Provider Directory

National Provider Directory

Locations

15450 Ida St
Ste 100
Bennington, NE 68007
Phone (701) 799-6453

Practitioners & affiliated clinicians

Practitioners 1

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": "1663632000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1663632000000",
    "number": "1962125492",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27330 W CENTER RD",
            "city": "WATERLOO",
            "state": "NE",
            "postal_code": "680696814",
            "telephone_number": "701-799-6453"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15450 IDA STREET",
            "address_2": "SUITE 100",
            "city": "BENNINGTON",
            "state": "NE",
            "postal_code": "68007",
            "telephone_number": "701-799-6453"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WATERFORD DENTAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-09-20",
        "last_updated": "2022-09-20",
        "certification_date": "2022-09-16",
        "status": "A",
        "authorized_official_last_name": "RISING",
        "authorized_official_first_name": "BRENT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "701-799-6453",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bennington, NE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 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.