Provider Demographics
NPI:1518539493
Name:NORTHEAST LINCOLN FAMILY DENTISTRY LLC
Entity Type:Organization
Organization Name:NORTHEAST LINCOLN FAMILY DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HR MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:R
Authorized Official - Last Name:NANTKES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-309-0483
Mailing Address - Street 1:8521 EXPRESS DRIVE
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68507
Mailing Address - Country:US
Mailing Address - Phone:402-890-8000
Mailing Address - Fax:531-500-5129
Practice Address - Street 1:8521 EXPRESS DRIVE
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68507
Practice Address - Country:US
Practice Address - Phone:402-890-8000
Practice Address - Fax:531-500-5129
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-12
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty