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Organization
BS DENTISTRY PC
Active
Organization
BS DENTISTRY PC
Active
Other names
Sudman Dental
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SHANE GALEN SUDMAN DDS, PC (OWNER, PRESIDENT)
(773) 597-8863
Entity
Organization
Contact information
Practice address
220 N 89TH ST STE 203, OMAHA, NE 68114-4072
(773) 597-8863
Mailing address
220 N 89TH ST STE 203, OMAHA, NE 68114-4072
(773) 597-8863
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
7064
NE
Other
Enumeration date
01/02/2018
Last updated
01/04/2018
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