| Shadow Ridge Dental | |
|
19103 Mason Plz Elkhorn NE 68022-5659 | |
| (402) 933-0525 | |
| (402) 933-2925 |
| Full Name | Shadow Ridge Dental |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 19103 Mason Plz, Elkhorn, Nebraska |
| Authorized Official Name and Position | James W Becker (OWNER) |
| Authorized Official Contact | 4029330525 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Shadow Ridge Dental 19103 Mason Plz Elkhorn NE 68022-5659 Ph: (402) 933-0525 | Shadow Ridge Dental 19103 Mason Plz Elkhorn NE 68022-5659 Ph: (402) 933-0525 |
| NPI Number | 1073811014 |
|---|---|
| Provider Enumeration Date | 02/28/2011 |
| Last Update Date | 02/28/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073811014 | NPI | - | NPPES |
| 100251659-00 | Medicaid | NE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 4791 (Nebraska) | Primary |
| 1223G0001X | Dentist - General Practice | 4488 (Nebraska) | Secondary |
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