Provider Demographics
NPI:1134203987
Name:KRALIK FAMILY DENTAL CENTER PC
Entity type:Organization
Organization Name:KRALIK FAMILY DENTAL CENTER PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:KRALIK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:402-372-2418
Mailing Address - Street 1:910 N LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:WEST POINT
Mailing Address - State:NE
Mailing Address - Zip Code:68788-1002
Mailing Address - Country:US
Mailing Address - Phone:402-372-2418
Mailing Address - Fax:402-372-5060
Practice Address - Street 1:910 N LINCOLN ST
Practice Address - Street 2:
Practice Address - City:WEST POINT
Practice Address - State:NE
Practice Address - Zip Code:68788-1002
Practice Address - Country:US
Practice Address - Phone:402-372-2418
Practice Address - Fax:402-372-5060
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KRALIK FAMILY DENTAL CENTER PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-25
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE64181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025402600Medicaid
NE10025157600Medicaid