Individual
DR. MARK LEROY VANICEK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
6101 VILLAGE DR, STE 102, LINCOLN, NE 68516-5830
(402) 420-2600
(402) 420-2963
Mailing address
6101 VILLAGE DR, STE 102, LINCOLN, NE 68516-5830
(402) 420-2600
(402) 420-2963
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5311
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05649
BLUE CROSS BLUE SHIELD
NE
05
—
47076193500
—
NE
Enumeration date
11/08/2006
Last updated
07/08/2007
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