| NPI | 1205127347 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GERALD JOHN MANCUSO Vice President 402-397-7799 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NE 5075) |
| Enumeration Date | 2011-04-24 |
| Last Update Date | 2011-04-24 |