Healthcare Provider Details

I. General information

NPI: 1194753756
Provider Name (Legal Business Name): DENNIS ELOF NILSSON D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10835 COTTONWOOD LN
OMAHA NE
68164-2677
US

IV. Provider business mailing address

12826 BINNEY ST
OMAHA NE
68164-4244
US

V. Phone/Fax

Practice location:
  • Phone: 402-960-2993
  • Fax:
Mailing address:
  • Phone: 402-493-3894
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number5923
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: