Provider Demographics
NPI:1750755831
Name:TODAY'S DENTAL ELKHORN LLC
Entity type:Organization
Organization Name:TODAY'S DENTAL ELKHORN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:JAMISON
Authorized Official - Last Name:RISING
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:402-333-1120
Mailing Address - Street 1:20211 MANDERSON STREET
Mailing Address - Street 2:
Mailing Address - City:ELKHORN
Mailing Address - State:NE
Mailing Address - Zip Code:68138
Mailing Address - Country:US
Mailing Address - Phone:402-505-1910
Mailing Address - Fax:
Practice Address - Street 1:20211 MANDERSON STREET
Practice Address - Street 2:
Practice Address - City:ELKHORN
Practice Address - State:NE
Practice Address - Zip Code:68138
Practice Address - Country:US
Practice Address - Phone:402-505-1910
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-30
Last Update Date:2015-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE1650370OtherORAL SURGERY DENTIST RX ONLY