Provider Demographics
NPI:1780772301
Name:UNIVERSITY DENTAL ASSOCIATES
Entity type:Organization
Organization Name:UNIVERSITY DENTAL ASSOCIATES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIERECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:GENE
Authorized Official - Last Name:BERKHEIM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:402-472-2345
Mailing Address - Street 1:4000 E CAMPUS LOOP S RM 2037
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68583-0740
Mailing Address - Country:US
Mailing Address - Phone:402-472-8900
Mailing Address - Fax:402-472-0048
Practice Address - Street 1:4000 E CAMPUS LOOP S RM 2037
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68583-0740
Practice Address - Country:US
Practice Address - Phone:402-472-8900
Practice Address - Fax:402-472-0048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA576249Medicaid
IA576249Medicaid
NE=========00Medicaid