Provider Demographics
NPI:1346502598
Name:DAVID R. MACK, DDS, PC
Entity Type:Organization
Organization Name:DAVID R. MACK, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:MAICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-291-4468
Mailing Address - Street 1:11536 S 31ST ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68123-5529
Mailing Address - Country:US
Mailing Address - Phone:402-291-4468
Mailing Address - Fax:
Practice Address - Street 1:11536 S 31ST ST
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68123-5529
Practice Address - Country:US
Practice Address - Phone:402-291-4468
Practice Address - Fax:402-933-2014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-13
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty