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Organization
SOUTH 73 DENTAL LLC
Active
Organization
SOUTH 73 DENTAL LLC
Active
Other names
Premier Dental
Organization subpart
No
Provider details
NPI number
Authorized official
FAITH GASKINS (DIRECTOR OF CREDENTIALING)
(972) 869-3789
Entity
Organization
Contact information
Practice address
2420 S 73RD ST STE 300, OMAHA, NE 68124-2396
(402) 391-1919
Mailing address
2420 S 73RD ST STE 300, OMAHA, NE 68124-2396
(402) 391-1919
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
04/21/2021
Last updated
04/21/2021
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