Healthcare Provider Details

I. General information

NPI: 1912260019
Provider Name (Legal Business Name): PEDIATRIC DENTAL ARTS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2012
Last Update Date: 12/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7001 A ST SUITE 103
LINCOLN NE
68510-4299
US

IV. Provider business mailing address

7001 A ST SUITE 103
LINCOLN NE
68510-4299
US

V. Phone/Fax

Practice location:
  • Phone: 402-434-3367
  • Fax: 402-434-3368
Mailing address:
  • Phone: 402-434-3367
  • Fax: 402-434-3368

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number5241
License Number StateNE

VIII. Authorized Official

Name: DR. MELISSA JILL SVEEN
Title or Position: PRESIDENT
Credential: D.D.S., M.S.
Phone: 402-434-3367