K Q DENTAL PC NPI 1194897058

NPI Information

  • NPI: 1194897058
  • Provider Name: K Q DENTAL PC
  • Classification: Dentist - 1223G0001X
  • Specialization: General Practice
  • Entity Type: Organization
  • Doing Business As: PINE LAKE DENTAL
  • Address: 2504 NORTH WEBB RD
    GRAND ISLAND, NE
    ZIP 68803
  • Phone: (308) 381-7077

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NPI Details

K Q DENTAL PC is a general practice dentist in Grand Island, 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. K Q DENTAL PC NPI is 1194897058. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Pine Lake Dental.

The provider's business location address is:

2504 NORTH WEBB RD
GRAND ISLAND, NE
ZIP 68803
Phone: (308) 381-7077
Fax: (308) 381-1345

The provider's authorized official is Edward E. Quincy .
The authorized official title is President and has the following contact phone number (402) 447-6042.

The enumeration date for this NPI number is 11/15/2006 and was last updated on 7/6/2009.

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 Practice5962NEBRASKANo
21223G0001XDentistGeneral Practice5954NEBRASKANo
31223G0001XDentistGeneral Practice3376NEBRASKANo
41223G0001XDentistGeneral Practice5746NEBRASKANo
51223G0001XDentistGeneral Practice3530NEBRASKANo
61223G0001XDentistGeneral Practice6365NEBRASKANo
71223G0001XDentistGeneral Practice4543NEBRASKANo
81223G0001XDentistGeneral Practice5343NEBRASKANo
91223G0001XDentistGeneral Practice4467NEBRASKANo
101223G0001XDentistGeneral Practice5838NEBRASKANo
111223G0001XDentistGeneral Practice6759NEBRASKANo
121223G0001XDentistGeneral Practice6837No
131223G0001XDentistGeneral Practice6834NEBRASKAYes

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
1=========04MEDICAIDNEBRASKA
2=========31MEDICAIDNEBRASKA
3=========06MEDICAIDNEBRASKA
4=========05MEDICAIDNEBRASKA
5=========03MEDICAIDNEBRASKA
6=========13MEDICAIDNEBRASKA
7=========20MEDICAIDNEBRASKA
8=========17MEDICAIDNEBRASKA

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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