1255823456 NPI number — BROOKLYNN ASHLEY DEXTER DDS

Table of content: BROOKLYNN ASHLEY DEXTER DDS (NPI 1255823456)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255823456 NPI number — BROOKLYNN ASHLEY DEXTER DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DEXTER
Provider First Name:
BROOKLYNN
Provider Middle Name:
ASHLEY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255823456
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/14/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2501 30TH AVE STE A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KEARNEY
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68845-4015
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
308-338-2050
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
118 W FRONT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELM CREEK
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68836-7634
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
308-856-1050
Provider Business Practice Location Address Fax Number:
308-338-2055
Provider Enumeration Date:
06/04/2018

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  7455 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7455 . This is a "STATE OF NE DEPARTMENT OF HEALTH AND HUMAN SERVICES DIVISION OF PUBLIC HEALTH" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".




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