Organization
METRO WEST DENTAL SPECIALTY GROUP
Active
Other names
Metro West Ortho & Perio
Organization subpart
No
Provider details
NPI number
Authorized official
AMY MURILLO (INSURANCE COORDINATOR)
(402) 999-1016
Entity
Organization
Contact information
Practice address
12225 W GILES RD, LA VISTA, NE 68128-5801
(402) 614-7022
(402) 614-7122
Mailing address
12225 W GILES RD, LA VISTA, NE 68128-5801
(402) 614-7022
(402) 614-7122
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
—
—
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1366625816
NPI
NE
01
—
1376730143
NPI
NE
01
—
1982802096
NPI
NE
Enumeration date
12/05/2022
Last updated
12/05/2022
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