Healthcare Provider Details

I. General information

NPI: 1992097778
Provider Name (Legal Business Name): SE NEBRASKA DENTAL GROUP, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2011
Last Update Date: 05/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 W ELDORA AVE
WEEPING WATER NE
68463-4201
US

IV. Provider business mailing address

105 W ELDORA AVE P.O. BOX 403
WEEPING WATER NE
68463-4201
US

V. Phone/Fax

Practice location:
  • Phone: 402-267-2325
  • Fax: 402-267-2725
Mailing address:
  • Phone: 402-267-2325
  • Fax: 402-267-2725

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number6172
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number6707
License Number StateNE

VIII. Authorized Official

Name: DR. MATTHEW C NEUMANN
Title or Position: OWNER
Credential: DDS
Phone: 402-267-2325