Healthcare Provider Details

I. General information

NPI: 1235470386
Provider Name (Legal Business Name): LINCOLN ENDODONTIC SPECIALISTS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2013
Last Update Date: 03/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 S 40TH ST STE 214
LINCOLN NE
68506-5247
US

IV. Provider business mailing address

1919 S 40TH ST STE 214
LINCOLN NE
68506-5247
US

V. Phone/Fax

Practice location:
  • Phone: 402-486-4380
  • Fax:
Mailing address:
  • Phone: 402-486-4380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number6571
License Number StateNE

VIII. Authorized Official

Name: CLIFF LEFFINGWELL
Title or Position: PRESIDENT
Credential:
Phone: 402-486-4380