Organization
SKYLINE PEDIATRIC DENTISTRY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VINCENT ROTHE (OWNER)
(402) 289-1574
Entity
Organization
Contact information
Practice address
1405 N 205TH ST, SUITE 100, ELKHORN, NE 68022-4740
(402) 289-1574
Mailing address
1405 N 205TH ST, SUITE 100, ELKHORN, NE 68022-4740
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10025787700
—
NE
Enumeration date
01/19/2012
Last updated
01/19/2012
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