| |
9635 Koi Rock Dr Lincoln NE 68526-9678 | |
(402) 499-0624 | |
Not Available |
Full Name | |
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Speciality | Dentist |
Location | 9635 Koi Rock Dr, Lincoln, Nebraska |
Authorized Official Name and Position | Farrah Plate (CEO) |
Authorized Official Contact | 4024990624 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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9635 Koi Rock Dr Lincoln NE 68526-9678 Ph: (402) 499-0624 | 9635 Koi Rock Dr Lincoln NE 68526-9678 Ph: (402) 499-0624 |
NPI Number | 1871028159 |
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Provider Enumeration Date | 04/25/2017 |
Last Update Date | 02/12/2024 |
Identifier | Type | State | Issuer |
---|---|---|---|
1871028159 | NPI | - | NPPES |
10025400000 | Medicaid | NE |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
122300000X | Dentist | 6546 (Nebraska) | Primary |
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