Provider Demographics
NPI:1740424027
Name:APOLLO DENTAL CONSULTING, P.C.
Entity Type:Organization
Organization Name:APOLLO DENTAL CONSULTING, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:VACEK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:402-786-2007
Mailing Address - Street 1:13220 CALLUM DR STE 5
Mailing Address - Street 2:
Mailing Address - City:WAVERLY
Mailing Address - State:NE
Mailing Address - Zip Code:68462-2560
Mailing Address - Country:US
Mailing Address - Phone:402-786-2007
Mailing Address - Fax:402-786-2008
Practice Address - Street 1:13220 CALLUM DR STE 5
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:NE
Practice Address - Zip Code:68462-2560
Practice Address - Country:US
Practice Address - Phone:402-786-2007
Practice Address - Fax:402-786-2008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-30
Last Update Date:2009-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE67991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025738700Medicaid