Healthcare Provider Details

I. General information

NPI: 1518374743
Provider Name (Legal Business Name): NATHAN PERSELL DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2014
Last Update Date: 03/04/2026
Certification Date: 03/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5945 S 56TH ST STE 100
LINCOLN NE
68516-3394
US

IV. Provider business mailing address

3801 CAPE CHARLES CT
LINCOLN NE
68516-5424
US

V. Phone/Fax

Practice location:
  • Phone: 402-440-1369
  • Fax:
Mailing address:
  • Phone: 402-440-1369
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number7179
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number7179
License Number StateNE
# 3
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number38248
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: