Healthcare Provider Details

I. General information

NPI: 1023544467
Provider Name (Legal Business Name): TOMASZ CZECHURA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2017
Last Update Date: 07/28/2021
Certification Date: 06/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 S 56TH ST STE A
LINCOLN NE
68506-3745
US

IV. Provider business mailing address

9303 SWAN CREEK RD
LINCOLN NE
68520-1498
US

V. Phone/Fax

Practice location:
  • Phone: 402-327-9400
  • Fax:
Mailing address:
  • Phone: 224-305-0096
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number7696
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: