| NPI | 1962516781 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERRY MALCOLM Owner/President 402-245-4636 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: NE 5779) |
| Enumeration Date | 2006-08-18 |
| Last Update Date | 2015-06-29 |