Fort Theatre Dentistry
LBN: Fort Theatre Dentistry
Fort Theatre Dentistry is an health care organization with primary practice located at 2205 Central Ave , Kearney NE 68847-5346. The organization recently has 3 registered licenses in different health care specialties including Dental Providers / Dentist, Dental Providers / Oral and Maxillofacial Surgery, Dental Providers / Orthodontics and Dentofacial Orthopedics. Dental Providers / Dentist is the primary health care specialty.
Fort Theatre Dentistry can be contacted via phone (308) 237-5853, or through Martin, Walter D via phone (308) 237-5853.
Contact Information
Primary practice address
2205 Central Ave
Kearney NE 68847-5346
Phone: (308) 237-5853
Fax: (308) 237-5089
Website:
Authorized official contact:
Name: Martin, Walter D Doctor of Dental Medicine (DMD)
Phone: (308) 237-5853
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / Dentist | 122300000X | ||
| Dental Providers / Oral and Maxillofacial Surgery | 1223S0112X | ||
| Dental Providers / Orthodontics and Dentofacial Orthopedics | 1223X0400X |
Profile Details
| NPI number | 1568670537 |
|---|---|
| LBN Legal business name | Fort Theatre Dentistry |
| DBA Doing business as | |
| Authorized official | Martin, Walter D Doctor of Dental Medicine (DMD) |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | May 21st, 2007 |
| Last updated | Aug 22nd, 2020 - about 4 years ago |
1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1568670537 | NPPES |
| Nebraska | MEDICAID | 100252764-00 |
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