Organization
MIBOCA 1 LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RAFAELA MONICA ROMERO (MANAGER)
(402) 331-0701
Entity
Organization
Contact information
Practice address
5305 S 96TH ST, OMAHA, NE 68127-3317
(402) 331-0701
(402) 331-7130
Mailing address
5305 S 96TH ST, OMAHA, NE 68127-3317
(402) 331-0701
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
10/16/2020
Last updated
10/16/2020
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