| NPI | 1518456250 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAURA FERGUSON FORAL Owner 402-215-3987 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Additional Taxonomies | 122300000X Dentist |
| Enumeration Date | 2018-05-08 |
| Last Update Date | 2018-05-08 |