Healthcare Provider Details

I. General information

NPI: 1568723294
Provider Name (Legal Business Name): PIONEER GREENS DENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2012
Last Update Date: 05/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4444 S 86TH ST
LINCOLN NE
68526-9253
US

IV. Provider business mailing address

4444 SOUTH 86TH STREET
LINCOLN NE
68526
US

V. Phone/Fax

Practice location:
  • Phone: 402-483-7502
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. EUGENE CHRIS HAAG
Title or Position: OWNER
Credential: D.D.S.
Phone: 402-483-7502