Provider Demographics
NPI:1629197579
Name:NOSWORTHY, MARIA TANCHULING (DDS)
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:TANCHULING
Last Name:NOSWORTHY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:838 HIDDEN HILLS DR
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68005-2738
Mailing Address - Country:US
Mailing Address - Phone:402-291-5485
Mailing Address - Fax:
Practice Address - Street 1:900 W MISSION AVE
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68005-3945
Practice Address - Country:US
Practice Address - Phone:402-291-5842
Practice Address - Fax:402-291-1621
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE6669122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025186200Medicaid