Healthcare Provider Details

I. General information

NPI: 1235567769
Provider Name (Legal Business Name): EDWARD JOHN VIGNA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2013
Last Update Date: 10/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 SOUTH 40TH STREET
LINCOLN NE
68506
US

IV. Provider business mailing address

3600 SOUTH 40TH STREET
LINCOLN NE
68506
US

V. Phone/Fax

Practice location:
  • Phone: 402-770-7070
  • Fax: 402-484-8123
Mailing address:
  • Phone: 402-770-7070
  • Fax: 402-484-8123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number4347
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: