# WILLIAMSBURG DENTAL LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Parent organization:** WILLIAMSBURG DENTAL LLC
- **Other names:** Williamsburg Dental Piedmont
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1043727092
- **Legal business name:** WILLIAMSBURG DENTAL LLC
- **Authorized official:** BONNIE L GALL (CLINICAL COORDINATOR)
- **Authorized official phone:** (402) 904-6005

## Contact information

- **Practice address:** 1265 S COTNER BLVD, LINCOLN, NE 68510-4975
- **Practice address phone:** (402) 420-2222
- **Mailing address:** 6930 L ST STE B, LINCOLN, NE 68510-2456
- **Mailing address phone:** (402) 904-6005

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 5965 | NE | Yes |

## Other

- **Enumeration date:** 12/29/2017
- **Last updated:** 12/29/2017

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 51070558700 | — | NE |