| NPI | 1164856084 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLY LOUISE RUSSELL Partner, Dentist 402-376-1942 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: NE 7069) |
| Enumeration Date | 2013-08-27 |
| Last Update Date | 2013-08-27 |