Provider Demographics
NPI:1144687864
Name:MARK FRILL DDS PC
Entity type:Organization
Organization Name:MARK FRILL DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:FRILL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:402-699-0229
Mailing Address - Street 1:9731 GILES ROAD
Mailing Address - Street 2:
Mailing Address - City:LAVISTA
Mailing Address - State:NE
Mailing Address - Zip Code:68128-2930
Mailing Address - Country:US
Mailing Address - Phone:402-537-4620
Mailing Address - Fax:402-537-4346
Practice Address - Street 1:9731 GILES ROAD
Practice Address - Street 2:
Practice Address - City:LAVISTA
Practice Address - State:NE
Practice Address - Zip Code:68128-2930
Practice Address - Country:US
Practice Address - Phone:402-537-4620
Practice Address - Fax:402-537-4346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-26
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE62251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty