Individual
CORI S AMEND
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DDS PC
Contact information
Practice address
1413 S 13 ST, LINCOLN, NE 68502
(402) 474-5504
(402) 474-5502
Mailing address
1413 S 13 ST, LINCOLN, NE 68502
(402) 474-5504
(402) 474-5502
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5927
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
47078471400
—
NE
Enumeration date
05/09/2007
Last updated
08/16/2023
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