Organization
WAHOO DENTAL ASSOCIATES, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JASON P. GLOCK D.D.S. (PARTNER)
(402) 443-5959
Entity
Organization
Contact information
Practice address
357 E 4TH ST, WAHOO, NE 68066-1920
(402) 443-5959
Mailing address
357 E 4TH ST, WAHOO, NE 68066-1920
(402) 443-5959
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
6253
NE
1223G0001X
General Practice Dentistry
6635
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10025583000
—
NE
Enumeration date
07/29/2006
Last updated
04/03/2015
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