Provider Demographics
NPI:1912260019
Name:PEDIATRIC DENTAL ARTS, P.C.
Entity Type:Organization
Organization Name:PEDIATRIC DENTAL ARTS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:JILL
Authorized Official - Last Name:SVEEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:402-434-3367
Mailing Address - Street 1:7001 A ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-4299
Mailing Address - Country:US
Mailing Address - Phone:402-434-3367
Mailing Address - Fax:402-434-3368
Practice Address - Street 1:7001 A ST
Practice Address - Street 2:SUITE 103
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-4299
Practice Address - Country:US
Practice Address - Phone:402-434-3367
Practice Address - Fax:402-434-3368
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-22
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE52411223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47069564500Medicaid
NE10026205700Medicaid