Provider Demographics
NPI:1679846299
Name:ASBJORNSON, JON CARVEL (DDS)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:CARVEL
Last Name:ASBJORNSON
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 1:2810 S. 48TH STREET
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-3391
Mailing Address - Country:US
Mailing Address - Phone:402-483-4171
Mailing Address - Fax:402-483-4899
Practice Address - Street 1:2810 S. 48TH STREET
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-3391
Practice Address - Country:US
Practice Address - Phone:402-483-4171
Practice Address - Fax:402-483-4899
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-13
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE54831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice