Healthcare Provider Details

I. General information

NPI: 1437445723
Provider Name (Legal Business Name): NOAH LUKE PISKORSKI DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2011
Last Update Date: 07/09/2021
Certification Date: 07/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1626 L ST
ORD NE
68862-0224
US

IV. Provider business mailing address

PO BOX 224 1626 L ST.
ORD NE
68862-0224
US

V. Phone/Fax

Practice location:
  • Phone: 308-728-3756
  • Fax: 308-728-3207
Mailing address:
  • Phone: 308-346-4988
  • Fax: 308-346-9103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number6961
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: