Provider Demographics
NPI:1124848254
Name:DENTAL PROFESSIONALS OF NEBRASKA, PC
Entity type:Organization
Organization Name:DENTAL PROFESSIONALS OF NEBRASKA, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CRED COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:CEMYIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDOUGAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-764-8609
Mailing Address - Street 1:15884 HULL STREET RD
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23832-2178
Mailing Address - Country:US
Mailing Address - Phone:804-575-3320
Mailing Address - Fax:804-575-3324
Practice Address - Street 1:19013 OAKMONT DR
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68136-4345
Practice Address - Country:US
Practice Address - Phone:804-575-3320
Practice Address - Fax:804-575-3324
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DENTAL PROFESSIONALS OF NEBRASKA, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-10-14
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty