RESTOREU LLC
NPI: 1467155333
· SOUTH SIOUX CITY, NE 68776
· General Practice Dentistry
· NPI assigned 03/22/2023
$108.04
Total Medicaid Paid
Provider Details
| Authorized Official | BALLER, RYAN (OWNER/DENTIST) |
| NPI Enumeration Date | 03/22/2023 |
Related Entities
Other providers sharing the same authorized official: BALLER, RYAN
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2023 |
31 |
$108.04 |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
31 |
14 |
$108.04 |