Organization
SUMMIT DENTAL HEALTH - BLONDO LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
COREZ LOGAN (CREDENTIALING SPECIALIST)
(502) 254-8500
Entity
Organization
Contact information
Practice address
2005 N 90TH ST, OMAHA, NE 68134-6002
(402) 799-1016
(402) 513-2745
Mailing address
PO BOX 437169, LOUISVILLE, KY 40253-7169
(502) 254-8500
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
02/02/2015
Last updated
02/02/2015
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