Provider Demographics
NPI:1063778132
Name:DENTAL CARE CENTER PC
Entity type:Organization
Organization Name:DENTAL CARE CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:PROF
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:P
Authorized Official - Last Name:SWEENEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:402-592-1773
Mailing Address - Street 1:7975 L ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68127-1731
Mailing Address - Country:US
Mailing Address - Phone:402-592-1773
Mailing Address - Fax:402-932-2547
Practice Address - Street 1:7975 L ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68127-1731
Practice Address - Country:US
Practice Address - Phone:402-592-1773
Practice Address - Fax:402-932-2547
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-03
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE4890122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
473184OtherUNITED CONCORDIA
NE5366OtherBLUE CROSS BLUE SHIELD OF NEBRASKA
IA0905463Medicaid
473184OtherUNITED CONCORDIA