Provider Demographics
NPI:1063699122
Name:SARTORI, PETER III (DDS)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:
Last Name:SARTORI
Suffix:III
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:PETER
Other - Middle Name:
Other - Last Name:SARTORI
Other - Suffix:III
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:300 N 44TH
Mailing Address - Street 2:SUITE 108
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68503
Mailing Address - Country:US
Mailing Address - Phone:402-466-1121
Mailing Address - Fax:402-466-1180
Practice Address - Street 1:300 N 44TH
Practice Address - Street 2:SUITE 108
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68503
Practice Address - Country:US
Practice Address - Phone:402-466-1121
Practice Address - Fax:402-466-1180
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-30
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE6063122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE91184966800Medicaid