| NPI | 1699193169 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY ELLEN GLENN Business Manager 402-488-5275 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2014-04-02 |
| Last Update Date | 2014-04-02 |