Provider Demographics
NPI:1811000292
Name:FAMILY DENTAL PC
Entity Type:Organization
Organization Name:FAMILY DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LANCE
Authorized Official - Middle Name:B
Authorized Official - Last Name:LINDENMUTH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:402-423-9045
Mailing Address - Street 1:5930 SOUTH 58TH STREET
Mailing Address - Street 2:SUITE E
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516
Mailing Address - Country:US
Mailing Address - Phone:402-423-9045
Mailing Address - Fax:402-423-9048
Practice Address - Street 1:5930 SOUTH 58TH STREET
Practice Address - Street 2:SUITE E
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516
Practice Address - Country:US
Practice Address - Phone:402-423-9045
Practice Address - Fax:402-423-9048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE55661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========13Medicaid