| NPI | 1386669133 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DENNIS WILLIAM BLACK President 308-633-1760 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NE 5558) |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2020-08-22 |