# MARANATHA DENTAL GROUP

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1972861847
- **Authorized official:** DR. JUSTIN T DWORAK DDS (OWNER)
- **Authorized official phone:** (402) 489-3837

## Contact information

- **Practice address:** 1600 S. 70TH ST., STE 200, LINCOLN, NE 68506-1568
- **Practice address phone:** (402) 489-3837
- **Practice address fax:** (402) 489-3931
- **Mailing address:** 1600 S 70TH ST, STE 200, LINCOLN, NE 68506-1568
- **Mailing address phone:** (402) 489-3837
- **Mailing address fax:** (402) 489-3931

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 4314 | NE | Yes |
| 122300000X | Dentist | 6116 | NE | — |

## Other

- **Enumeration date:** 04/30/2012
- **Last updated:** 04/30/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 47063464200 | — | NE |