Provider Demographics
NPI:1366612665
Name:KONTRAS AND PALMER DDS PC
Entity type:Organization
Organization Name:KONTRAS AND PALMER DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:PALMER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:402-467-1116
Mailing Address - Street 1:6129 HAVELOCK AVE
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68507-1234
Mailing Address - Country:US
Mailing Address - Phone:402-467-1116
Mailing Address - Fax:402-467-1117
Practice Address - Street 1:6129 HAVELOCK AVE
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68507-1234
Practice Address - Country:US
Practice Address - Phone:402-467-1116
Practice Address - Fax:402-467-1117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-03
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE44181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty