| NPI | 1811088693 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAY DANIEL SAMUELSON President 402-445-4647 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NE 6078) |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2020-08-22 |