Healthcare Provider Details

I. General information

NPI: 1235231382
Provider Name (Legal Business Name): DR. JON C ASBJORNSON D.D.S. P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2810 S 48TH ST
LINCOLN NE
68506-3391
US

IV. Provider business mailing address

2810 S 48TH ST
LINCOLN NE
68506-3391
US

V. Phone/Fax

Practice location:
  • Phone: 402-483-4171
  • Fax: 402-483-4899
Mailing address:
  • Phone: 402-483-4171
  • Fax: 402-483-4899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number5483
License Number StateNE

VIII. Authorized Official

Name: DR. JON C. ASBJORNSON
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 402-483-4171