Healthcare Provider Details

I. General information

NPI: 1013118439
Provider Name (Legal Business Name): WILLIAM G LURZ DDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2007
Last Update Date: 08/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 E SOUTH ST
BASSETT NE
68714-0098
US

IV. Provider business mailing address

102 E SOUTH ST PO BOX 98 BASSETT DENTAL CLINIC
BASSETT NE
68714-0098
US

V. Phone/Fax

Practice location:
  • Phone: 402-684-2919
  • Fax: 402-684-2919
Mailing address:
  • Phone: 402-684-2919
  • Fax: 402-684-2919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number5283
License Number State
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number5283
License Number StateNE

VIII. Authorized Official

Name: WILLIAM G LURZ
Title or Position: OWNER OF DENTAL CLINIC
Credential:
Phone: 402-684-2919