| NPI | 1821954405 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER HERITAGE Credentialing Manager 402-805-4516 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Enumeration Date | 2025-12-29 |
| Last Update Date | 2025-12-29 |