Organization
HEARTLAND ENDODONTIC SPECIALISTS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LARRY JOHNSON ELLISON DDS (PARTNER)
(402) 393-5050
Entity
Organization
Contact information
Practice address
615 N 90TH ST, OMAHA, NE 68114-2821
(402) 393-5050
(402) 393-3401
Mailing address
615 N 90TH ST, OMAHA, NE 68114-2821
(402) 393-5050
(402) 393-3401
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
—
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
460446
UNITED CONCORDIA
NE
Enumeration date
09/20/2006
Last updated
08/28/2008
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