| NPI | 1275029209 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CASSANDRA BORMANN Billing Supervisor 402-562-8955 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NE 4935) |
| Additional Taxonomies | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2018-07-02 |
| Last Update Date | 2023-03-16 |