| Skyline Pediatric Dentistry Llc | |
|
1405 N 205th St Suite 100 Elkhorn NE 68022-4740 | |
| (402) 289-1574 | |
| Not Available |
| Full Name | Skyline Pediatric Dentistry Llc |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 1405 N 205th St, Elkhorn, Nebraska |
| Authorized Official Name and Position | Vincent Rothe (OWNER) |
| Authorized Official Contact | 4022891574 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Skyline Pediatric Dentistry Llc 1405 N 205th St Suite 100 Elkhorn NE 68022-4740 Ph: () - | Skyline Pediatric Dentistry Llc 1405 N 205th St Suite 100 Elkhorn NE 68022-4740 Ph: (402) 289-1574 |
| NPI Number | 1699046847 |
|---|---|
| Provider Enumeration Date | 01/19/2012 |
| Last Update Date | 01/19/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699046847 | NPI | - | NPPES |
| 10025787700 | Medicaid | NE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | (* (Not Available)) | Primary |
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