Organization
BS DENTISTRY PC
Active
Other names
Sudman Dental
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SHANE GALEN SUDMAN DDS, PC (OWNER, PRESIDENT)
(773) 597-8863
Entity
Organization
Contact information
Practice address
220 N 89TH ST STE 203, OMAHA, NE 68114-4072
(773) 597-8863
Mailing address
220 N 89TH ST STE 203, OMAHA, NE 68114-4072
(773) 597-8863
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
7064
NE
Other
Enumeration date
01/02/2018
Last updated
01/04/2018
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