MEDICARE: DENTAL WELLNESS CENTER PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist

General Provider Information

NPI Number	:	1639956329
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DENTAL WELLNESS CENTER PC

Provider Business Mailing Address
First Line	:	1310 ANDREWS DR
Second Line	:
City	:	NORFOLK
State	:	NE
Zip	:	68701-2760
Country	:	US
Telephone Number	:	402-371-3745
Fax Number	:

Provider Business Practice Location Address
First Line	:	1310 ANDREWS DR
Second Line	:
City	:	NORFOLK
State	:	NE
Zip	:	68701-2760
Country	:	US
Telephone Number	:	402-371-3745
Fax Number	:

Authorized Official
Title or Position	:	OPERATIONS MANAGER
Name	:	THOMAS J STANTON
Credential	:
Telephone Number	:	402-860-1705

Provider Enumeration Date	:	09/14/2023
Last Update Date	:	09/14/2023

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Directions to “DENTAL WELLNESS CENTER PC ” Practice Location

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