Provider Demographics
NPI:1407105299
Name:STARK AND JOHNSON LLC
Entity Type:Organization
Organization Name:STARK AND JOHNSON LLC
Other - Org Name:LINCOLN PEDIATRIC DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INSURANCE AND BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNI
Authorized Official - Middle Name:K
Authorized Official - Last Name:WALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-476-1500
Mailing Address - Street 1:4301 S 80TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-4404
Mailing Address - Country:US
Mailing Address - Phone:402-476-4301
Mailing Address - Fax:402-476-4305
Practice Address - Street 1:4301 S 80TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-4404
Practice Address - Country:US
Practice Address - Phone:402-476-4301
Practice Address - Fax:402-476-4305
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STARK AND JOHNSON, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-09-07
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1223P0221X
NE68811223P0221X
NE69011223P0221X
NE68381223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty