# SOUTH LINCOLN DENTAL LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** SOUTH LINCOLN DENTAL LLC
- **Other names:** Williamsburg Dental - South Street
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1922525450
- **Legal business name:** SOUTH LINCOLN 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) 904-6005
- **Practice address fax:** (402) 904-6005
- **Mailing address:** WILLIAMSBURG DENTAL SOUTH STREET, 6930 L STREET SUITE B, LINCOLN, NE 68510
- **Mailing address phone:** (402) 904-6005

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 7178 | NE | Yes |

## Other

- **Enumeration date:** 08/25/2017
- **Last updated:** 03/17/2018