Provider Demographics
NPI:1295904530
Name:ETZELMILLER, ARJAY J (DDS)
Entity type:Individual
Prefix:
First Name:ARJAY
Middle Name:J
Last Name:ETZELMILLER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 PINE LAKE RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516
Mailing Address - Country:US
Mailing Address - Phone:402-420-2266
Mailing Address - Fax:402-420-2310
Practice Address - Street 1:3200 PINE LAKE RD
Practice Address - Street 2:SUITE C
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-6035
Practice Address - Country:US
Practice Address - Phone:402-420-2266
Practice Address - Fax:402-420-2310
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-20
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE59621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice