Provider Demographics
NPI:1497840623
Name:GL MENDLIK DDS PC
Entity type:Organization
Organization Name:GL MENDLIK DDS PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:GARRETT
Authorized Official - Last Name:MENDLIK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MS
Authorized Official - Phone:402-334-2000
Mailing Address - Street 1:17775 MASON STREET
Mailing Address - Street 2:STE 2
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68118
Mailing Address - Country:US
Mailing Address - Phone:402-334-2000
Mailing Address - Fax:402-334-3024
Practice Address - Street 1:1830 N BELL ST
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:NE
Practice Address - Zip Code:68025-3161
Practice Address - Country:US
Practice Address - Phone:402-334-2000
Practice Address - Fax:402-334-3024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE60971223X0400X
NE36481223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========00Medicaid