Organization
SOUTH 73 DENTAL LLC
Active
Other names
Premier Dental
Organization subpart
No
Provider details
NPI number
Authorized official
FAITH GASKINS (DIRECTOR OF CREDENTIALING)
(972) 869-3789
Entity
Organization
Contact information
Practice address
2420 S 73RD ST STE 300, OMAHA, NE 68124-2396
(402) 391-1919
Mailing address
2420 S 73RD ST STE 300, OMAHA, NE 68124-2396
(402) 391-1919
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
04/21/2021
Last updated
04/21/2021
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