| Maranatha Dental Group | |
|
1600 S. 70th St. Ste 200 Lincoln NE 68506-1568 | |
| (402) 489-3837 | |
| (402) 489-3931 |
| Full Name | Maranatha Dental Group |
|---|---|
| Speciality | Dentist |
| Location | 1600 S. 70th St., Lincoln, Nebraska |
| Authorized Official Name and Position | Justin T Dworak (OWNER) |
| Authorized Official Contact | 4024893837 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Maranatha Dental Group 1600 S 70th St Ste 200 Lincoln NE 68506-1568 Ph: (402) 489-3837 | Maranatha Dental Group 1600 S. 70th St. Ste 200 Lincoln NE 68506-1568 Ph: (402) 489-3837 |
| NPI Number | 1972861847 |
|---|---|
| Provider Enumeration Date | 04/30/2012 |
| Last Update Date | 04/30/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972861847 | NPI | - | NPPES |
| 47063464200 | Medicaid | NE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 4314 (Nebraska) | Primary |
| 122300000X | Dentist | 6116 (Nebraska) | Secondary |
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