| NPI | 1811648363 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNI K WALL Insurance And Billing Manager 402-476-1500 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry |
| Enumeration Date | 2022-01-17 |
| Last Update Date | 2022-01-17 |