Provider Demographics
NPI:1275620403
Name:YORK DENTAL ARTS CLINIC PC
Entity Type:Organization
Organization Name:YORK DENTAL ARTS CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:S
Authorized Official - Last Name:WIETING
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:402-362-3379
Mailing Address - Street 1:122 W 6TH ST
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:NE
Mailing Address - Zip Code:68467-2920
Mailing Address - Country:US
Mailing Address - Phone:402-362-3379
Mailing Address - Fax:
Practice Address - Street 1:122 W 6TH ST
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:NE
Practice Address - Zip Code:68467-2920
Practice Address - Country:US
Practice Address - Phone:402-362-3379
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-09
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE47851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty