Basic Information
| Provider Information | |||||||||
| NPI: | 1790449247 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NE SPECIALTY DENTAL SERVICES LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 401 CHURCH ST STE 1400 | ||||||||
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| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372192214 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5046380303 | ||||||||
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| Practice Location | |||||||||
| Address1: | 13215 BIRCH DR STE 100 | ||||||||
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| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681645431 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4023900770 | ||||||||
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| ProviderEnumerationDate: | 10/29/2021 | ||||||||
| LastUpdateDate: | 10/29/2021 | ||||||||
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| AuthorizedOfficialLastName: | DASCH | ||||||||
| AuthorizedOfficialFirstName: | CHARLOTTE | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR OF PROVIDER RELATIOND | ||||||||
| AuthorizedOfficialTelephone: | 5046380303 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 10/29/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QS0112X | Y | Ambulatory Health Care Facilities | Clinic/Center | Oral and Maxillofacial Surgery |
No ID Information.