PEDIATRIC DENTISTRY P.C. NPI 1154750677

NPI Information

NPI: 1154750677
Provider Name: PEDIATRIC DENTISTRY, P.C.
Classification: Clinic/Center - 261QD0000X
Entity Type: Organization

Specialization: Dental

Address:
3901 PINE LAKE RD STE 250
LINCOLN, NE
ZIP 68516
Phone: (402) 423-3322
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PEDIATRIC DENTISTRY, P.C. is a dental clinic center in Lincoln, NE. PEDIATRIC DENTISTRY, P.C. NPI is 1154750677. The provider is registered as an organization entity type.

The provider's business location address is:

3901 PINE LAKE RD STE 250
LINCOLN, NE
ZIP 68516-497
Phone: (402) 423-3322

The provider's authorized official is Brent D Johnson .
The authorized official title is Pediatric Dentist and has the following contact phone number (402) 423-3322.

The enumeration date for this NPI number is 11/5/2013 and was last updated on 12/12/2018.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QD0000X	Clinic/Center	Dental	6566	NEBRASKA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	10025649100	MEDICAID	NEBRASKA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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