Provider Demographics
NPI:1275521205
Name:WORTMAN, PAUL (DDS)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:WORTMAN
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 1:20281 WIRT ST
Mailing Address - Street 2:
Mailing Address - City:ELKHORN
Mailing Address - State:NE
Mailing Address - Zip Code:68022-2694
Mailing Address - Country:US
Mailing Address - Phone:402-289-3522
Mailing Address - Fax:402-289-0501
Practice Address - Street 1:20281 WIRT ST
Practice Address - Street 2:
Practice Address - City:ELKHORN
Practice Address - State:NE
Practice Address - Zip Code:68022-2694
Practice Address - Country:US
Practice Address - Phone:402-289-3522
Practice Address - Fax:402-289-0501
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-13
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE48611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice