Healthcare Provider Details

I. General information

NPI: 1114021201
Provider Name (Legal Business Name): LOUIS F OLBERDING DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2006
Last Update Date: 09/21/2023
Certification Date: 09/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 PINE LAKE RD STE 115
LINCOLN NE
68516-5427
US

IV. Provider business mailing address

3901 PINE LAKE RD STE 115
LINCOLN NE
68516-5427
US

V. Phone/Fax

Practice location:
  • Phone: 402-488-2325
  • Fax: 402-488-2763
Mailing address:
  • Phone: 402-488-2325
  • Fax: 402-488-2763

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number6209
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: