SHADOW RIDGE DENTAL NPI 1073811014

NPI Information

  • NPI: 1073811014
  • Provider Name: SHADOW RIDGE DENTAL
  • Classification: Dentist - 1223G0001X
  • Specialization: General Practice
  • Entity Type: Organization
  • Address: 19103 MASON PLZ
    ELKHORN, NE
    ZIP 68022
  • Phone: (402) 933-0525

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NPI Details

SHADOW RIDGE DENTAL is a general practice dentist in Elkhorn, NE. The provider is a general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. SHADOW RIDGE DENTAL NPI is 1073811014. The provider is registered as an organization entity type and is a multiple single specialty group.

The provider's business location address is:

19103 MASON PLZ
ELKHORN, NE
ZIP 68022-659
Phone: (402) 933-0525
Fax: (402) 933-2925

The provider's authorized official is James W Becker .
The authorized official title is Owner and has the following contact phone number (402) 933-0525.

The enumeration date for this NPI number is 2/28/2011 and was last updated on 2/28/2011.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
11223G0001XDentistGeneral Practice4488NEBRASKANo
21223G0001XDentistGeneral Practice4791NEBRASKAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1100251659-00MEDICAIDNEBRASKA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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