Mpda Broken Bow LLC

NPI #1376294298 in Broken Bow, Nebraska

Provider Information

NPI Number: 1376294298
Entity Type: Organization
Organization Name: Mpda Broken Bow LLC
Primary Specialty: Dentist
Enumeration Date: Jan 12, 2022
Last Updated: Jan 12, 2022

Practice Location

Address: 2021 SOUTH E
Address 2: SUITE 5
City: Broken Bow
State: Nebraska
ZIP Code: 68822
Phone: (308) 767-2004

Authorized Official

Name: BENJAMIN ALLEN LASHLEY, DDS
Title: SOLE MEMBER
Phone: (308) 534-1289

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist - General Practice — General Practice	1223G0001X
Dentist	122300000X	Primary

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