Provider Demographics
NPI:1588799407
Name:DWORAK, JEFF D (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEFF
Middle Name:D
Last Name:DWORAK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2110 TOWNE CENTER DR
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68123-6405
Mailing Address - Country:US
Mailing Address - Phone:402-296-5118
Mailing Address - Fax:402-885-8990
Practice Address - Street 1:2110 TOWNE CENTER DR
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68123-6405
Practice Address - Country:US
Practice Address - Phone:402-885-8990
Practice Address - Fax:402-885-8991
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE63131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE202172111OtherTAX ID#
NE6313OtherSTATE LICENSE
NE1345421OtherUNITED COCORIDA
NE05248OtherBLUECROSS BLUESHIELD
NE10025239900Medicaid