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General NPI Number Information
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NPI Number | 1023450137
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Entity Type | Organization
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Legal Business Name | GREAT PLAINS DENTAL SPECIALISTS P.C.
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Dates
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Enumeration Date | 07/18/2013
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Last Update Date | 07/18/2013
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Provider Practice Location Address
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Address Line | 1005 E 23RD ST SUITE 202
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City | FREMONT
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State | NE
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Zip | 68025-0800
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Country | US
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Telephone | 402-721-9926
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Fax | 402-721-9268
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Provider Business Mailing Address
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Address Line | 1005 E 23RD ST SUITE 202
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City | FREMONT
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State | NE
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Zip | 68025-0800
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Country | US
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Telephone | 402-721-9926
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Fax | 402-721-9268
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROBERT DARRELL CLINE JR.
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Credential | D.D.S.
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Telephone | 402-721-9926
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 6510
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License Number State | NE
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Taxonomy #2
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 6931
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License Number State | NE
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