| NPI | 1760626857 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | G A. PETERSON President 308-384-1172 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NE 4372) |
| Enumeration Date | 2009-04-21 |
| Last Update Date | 2009-04-21 |