# DR. JEFF D DWORAK

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1588799407
- **Gender:** Man
- **Credential:** DDS

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 6313 | NE | Yes |

## Other

- **Enumeration date:** 02/22/2007
- **Last updated:** 05/20/2019

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 05248 | BLUECROSS BLUESHIELD | NE |
| 05 | — | 10025239900 | — | NE |
| 01 | — | 1345421 | UNITED COCORIDA | NE |
| 01 | — | 202172111 | TAX ID\# | NE |
| 01 | — | 6313 | STATE LICENSE | NE |