| NPI | 1154970655 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRITTNEY WIEMER Practice Administrator 402-934-8999 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery |
| Enumeration Date | 2019-09-06 |
| Last Update Date | 2019-09-06 |