Provider Demographics
NPI:1578004115
Name:NBD LINCOLN PC
Entity Type:Organization
Organization Name:NBD LINCOLN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAWD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:402-964-2200
Mailing Address - Street 1:11336 S 96TH ST
Mailing Address - Street 2:
Mailing Address - City:PAPILLION
Mailing Address - State:NE
Mailing Address - Zip Code:68046-4209
Mailing Address - Country:US
Mailing Address - Phone:402-964-2200
Mailing Address - Fax:402-905-3666
Practice Address - Street 1:11336 S 96TH ST
Practice Address - Street 2:
Practice Address - City:PAPILLION
Practice Address - State:NE
Practice Address - Zip Code:68046-4209
Practice Address - Country:US
Practice Address - Phone:402-964-2200
Practice Address - Fax:402-905-3666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-15
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE72751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty