Organization
PEDIATRIC DENTAL SPECIALISTS OF GREATER NEBRASKA, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVE F JOHNSON (PRACTICE ADMINISTRATOR)
(402) 462-6557
Entity
Organization
Contact information
Practice address
601 N ST JOSEPH AVE, HASTINGS, NE 68902-0667
(402) 462-6557
(402) 461-4479
Mailing address
PO BOX 667, HASTINGS, NE 68902-0667
(402) 462-6557
(402) 461-4479
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10025036700
—
NE
Enumeration date
09/26/2006
Last updated
01/18/2019
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