Provider Demographics
NPI:1922302272
Name:JAMES AND SOUKUP DDS PC
Entity Type:Organization
Organization Name:JAMES AND SOUKUP DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:JEANNE
Authorized Official - Last Name:SOUKUP
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:402-476-8058
Mailing Address - Street 1:100 N 12TH ST
Mailing Address - Street 2:#502 CENTERSTONE
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68508-1410
Mailing Address - Country:US
Mailing Address - Phone:402-476-8058
Mailing Address - Fax:402-476-1763
Practice Address - Street 1:100 N 12TH ST
Practice Address - Street 2:#502 CENTERSTONE
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68508-1410
Practice Address - Country:US
Practice Address - Phone:402-476-8058
Practice Address - Fax:402-476-1763
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-30
Last Update Date:2010-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE62601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty