PEDIATRIC DENTISTRY P.C. NPI 1154750677

NPI Information

  • NPI: 1154750677
  • Provider Name: PEDIATRIC DENTISTRY, P.C.
  • Classification: Clinic/Center - 261QD0000X
  • Specialization: Dental
  • Entity Type: Organization
  • Address: 3901 PINE LAKE RD STE 250
    LINCOLN, NE
    ZIP 68516
  • Phone: (402) 423-3322

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NPI Details

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
1261QD0000XClinic/CenterDental6566NEBRASKAYes

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
110025649100MEDICAIDNEBRASKA

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: 11/21/2025

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