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1265 S Cotner Blvd Lincoln NE 68510-4975 | |
| (402) 420-2222 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 1265 S Cotner Blvd, Lincoln, Nebraska |
| Authorized Official Name and Position | Bonnie L Gall (CLINICAL COORDINATOR) |
| Authorized Official Contact | 4029046005 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
6930 L St Ste B Lincoln NE 68510-2456 Ph: (402) 904-6005 | 1265 S Cotner Blvd Lincoln NE 68510-4975 Ph: (402) 420-2222 |
| NPI Number | 1043727092 |
|---|---|
| Provider Enumeration Date | 12/29/2017 |
| Last Update Date | 12/29/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043727092 | NPI | - | NPPES |
| 51070558700 | Medicaid | NE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 5965 (Nebraska) | Primary |
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