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General NPI Number Information
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NPI Number | 1023414273
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Entity Type | Organization
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Legal Business Name | PERSHING ORTHODONTICS P.C.
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Dates
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Enumeration Date | 11/17/2014
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Last Update Date | 11/17/2014
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Provider Practice Location Address
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Address Line | 815 N MARIAN RD
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City | HASTINGS
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State | NE
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Zip | 68901-3489
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Country | US
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Telephone | 402-462-4173
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Fax | 402-462-5516
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Provider Business Mailing Address
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Address Line | 815 N MARIAN RD
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City | HASTINGS
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State | NE
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Zip | 68901-3489
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Country | US
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Telephone | 402-462-4173
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Fax | 402-462-5516
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Authorized Official
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Title or Position | OWNER
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Name | MATTHEW PERSHING
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Credential |
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Telephone | 402-469-5223
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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