Provider Demographics
NPI:1841372216
Name:FICKE ORTHODONTICS LLC
Entity type:Organization
Organization Name:FICKE ORTHODONTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:J
Authorized Official - Last Name:FICKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-475-6666
Mailing Address - Street 1:3100 O ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-1532
Mailing Address - Country:US
Mailing Address - Phone:402-475-6666
Mailing Address - Fax:402-475-9327
Practice Address - Street 1:3100 O ST
Practice Address - Street 2:SUITE 1
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-1532
Practice Address - Country:US
Practice Address - Phone:402-475-6666
Practice Address - Fax:402-475-9327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE59561223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025277300Medicaid