| NPI | 1336548106 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATTHEW DAVID ANDERSON Organizer 402-972-7751 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: MO 2014012737) |
| Enumeration Date | 2014-08-18 |
| Last Update Date | 2014-08-18 |