| NPI | 1700169679 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JILLIAN WALLEN Program Director 402-559-7954 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: NE 94) |
| Enumeration Date | 2011-09-27 |
| Last Update Date | 2011-09-27 |