Provider Demographics
NPI:1821086075
Name:DRAHOTA, LUMIR JOHN (DDS)
Entity Type:Individual
Prefix:DR
First Name:LUMIR
Middle Name:JOHN
Last Name:DRAHOTA
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 1:1629 E MILITARY AVE
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:NE
Mailing Address - Zip Code:68025-5463
Mailing Address - Country:US
Mailing Address - Phone:402-721-7255
Mailing Address - Fax:402-727-1586
Practice Address - Street 1:1629 E MILITARY AVE
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:NE
Practice Address - Zip Code:68025-5463
Practice Address - Country:US
Practice Address - Phone:402-721-7255
Practice Address - Fax:402-727-1586
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-12
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE5656122300000X
NE5650122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47072816300Medicaid