Basic Information
| Provider Information | |||||||||
| NPI: | 1144968207 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | NEMO DENTAL | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1133 COLLEGE AVE STE D202 | ||||||||
| Address2: | |||||||||
| City: | MANHATTAN | ||||||||
| State: | KS | ||||||||
| PostalCode: | 665022700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7859537401 | ||||||||
| FaxNumber: | 7857768415 | ||||||||
| Practice Location | |||||||||
| Address1: | 1133 COLLEGE AVE STE D202 | ||||||||
| Address2: | |||||||||
| City: | MANHATTAN | ||||||||
| State: | KS | ||||||||
| PostalCode: | 665022700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7859537401 | ||||||||
| FaxNumber: | 7857768415 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/26/2022 | ||||||||
| LastUpdateDate: | 05/26/2022 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | NEMECHEK | ||||||||
| AuthorizedOfficialFirstName: | ZACH | ||||||||
| AuthorizedOfficialMiddleName: | WARREN | ||||||||
| AuthorizedOfficialTitleorPosition: | DENTIST/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7852990550 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | DDS | ||||||||
| NPICertificationDate: | 05/26/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QD0000X | Y | Ambulatory Health Care Facilities | Clinic/Center | Dental |
No ID Information.