Healthcare Provider Details

I. General information

NPI: 1033030218
Provider Name (Legal Business Name): CJ DENTAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1513 CENTRAL AVE
NEBRASKA CITY NE
68410-2225
US

IV. Provider business mailing address

2424 N 81ST ST
LINCOLN NE
68507-3341
US

V. Phone/Fax

Practice location:
  • Phone: 402-873-5005
  • Fax:
Mailing address:
  • Phone: 715-416-1661
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. CORBIN SMITH
Title or Position: DENTIST
Credential: DDS
Phone: 605-228-6967