| NPI | 1972861847 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUSTIN T DWORAK Owner 402-489-3837 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NE 4314) |
| Additional Taxonomies | 122300000X Dentist (Licence: NE 6116) |
| Enumeration Date | 2012-04-30 |
| Last Update Date | 2012-04-30 |