| NPI | 1629354667 |
|---|---|
| Doing Business As | SOUTHROADS DENTAL &/OR DREAM DENTAL CARE |
| Entity Type | Organization |
| Authorized Contact | ROBERT FRAZIER COLWELL President/Owner 402-733-6066 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: NE 6236) |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental (Licence: IA 8073) |
| Enumeration Date | 2011-10-21 |
| Last Update Date | 2012-01-23 |