Provider Demographics
NPI:1558772681
Name:DENTAL PROFESSIONALS OF NEBRASKA, PC
Entity type:Organization
Organization Name:DENTAL PROFESSIONALS OF NEBRASKA, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:
Authorized Official - Last Name:VARNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-540-6077
Mailing Address - Street 1:3615 SUMMIT PLAZA DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68123-1003
Mailing Address - Country:US
Mailing Address - Phone:402-881-8069
Mailing Address - Fax:
Practice Address - Street 1:3615 SUMMIT PLAZA DR
Practice Address - Street 2:SUITE 101
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68123-1003
Practice Address - Country:US
Practice Address - Phone:402-881-8069
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DENTAL PROFESSIONALS OF NEBRASKA, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-05-12
Last Update Date:2014-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE6878122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty