Organization
PEDIATRIC DENTISTRY, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRENT D JOHNSON DDS (PEDIATRIC DENTIST)
(402) 423-3322
Entity
Organization
Contact information
Practice address
3901 PINE LAKE RD STE 250, LINCOLN, NE 68516-5497
(402) 423-3322
Mailing address
3901 PINE LAKE RD STE 250, LINCOLN, NE 68516-5497
(402) 423-3322
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
6566
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10025649100
—
NE
Enumeration date
11/05/2013
Last updated
12/12/2018
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