Provider Demographics
NPI:1699193169
Name:GENESIS ORTHODONTICS
Entity type:Organization
Organization Name:GENESIS ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:GLENN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-488-5275
Mailing Address - Street 1:7001 A STREET
Mailing Address - Street 2:SUITE 105
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-4205
Mailing Address - Country:US
Mailing Address - Phone:402-488-5275
Mailing Address - Fax:402-483-5200
Practice Address - Street 1:7001 A ST
Practice Address - Street 2:STE 105
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-4205
Practice Address - Country:US
Practice Address - Phone:402-488-5275
Practice Address - Fax:402-483-5200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-02
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty