Provider Demographics
NPI:1518145655
Name:ORAL PATHOLOGY LABORATORY
Entity Type:Organization
Organization Name:ORAL PATHOLOGY LABORATORY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NAGAMANI
Authorized Official - Middle Name:
Authorized Official - Last Name:NARAYANA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MS
Authorized Official - Phone:402-472-1355
Mailing Address - Street 1:PO BOX 830740
Mailing Address - Street 2:40TH AND HOLDREGE ST
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68583-0740
Mailing Address - Country:US
Mailing Address - Phone:402-472-1296
Mailing Address - Fax:402-472-2551
Practice Address - Street 1:4000 HOLDREGE ST ROOM 100
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68583-0740
Practice Address - Country:US
Practice Address - Phone:402-472-1296
Practice Address - Fax:402-472-2551
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNIVERSITY DENTAL ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-01-31
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47078998516Medicaid
NE094603Medicare PIN