Provider Demographics
NPI:1043086366
Name:DENTAL PROFESSIONALS OF NEBRASKA, PC
Entity Type:Organization
Organization Name:DENTAL PROFESSIONALS OF NEBRASKA, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING 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 1:5640 SOUTH ST STE 1
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-2231
Mailing Address - Country:US
Mailing Address - Phone:402-489-0787
Mailing Address - Fax:
Practice Address - Street 1:5640 SOUTH ST STE 1
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-2231
Practice Address - Country:US
Practice Address - Phone:402-489-0787
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DENTAL PROFESSIONALS OF NEBRASKA, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-11-28
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty