| Pediatric Dentistry, P.c. | |
|
3901 Pine Lake Rd Ste 250 Lincoln NE 68516-5497 | |
| (402) 423-3322 | |
| Not Available |
| Full Name | Pediatric Dentistry, P.c. |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 3901 Pine Lake Rd Ste 250, Lincoln, Nebraska |
| Authorized Official Name and Position | Brent D Johnson (PEDIATRIC DENTIST) |
| Authorized Official Contact | 4024233322 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Pediatric Dentistry, P.c. 3901 Pine Lake Rd Ste 250 Lincoln NE 68516-5497 Ph: (402) 423-3322 | Pediatric Dentistry, P.c. 3901 Pine Lake Rd Ste 250 Lincoln NE 68516-5497 Ph: (402) 423-3322 |
| NPI Number | 1154750677 |
|---|---|
| Provider Enumeration Date | 11/05/2013 |
| Last Update Date | 12/12/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154750677 | NPI | - | NPPES |
| 10025649100 | Medicaid | NE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 6566 (Nebraska) | Primary |
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