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General NPI Number Information
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NPI Number | 1063778132
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Entity Type | Organization
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Legal Business Name | DENTAL CARE CENTER PC
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Dates
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Enumeration Date | 04/03/2012
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Last Update Date | 04/03/2012
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Provider Practice Location Address
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Address Line | 7975 L ST
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City | OMAHA
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State | NE
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Zip | 68127-1731
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Country | US
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Telephone | 402-592-1773
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Fax | 402-932-2547
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Provider Business Mailing Address
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Address Line | 7975 L ST
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City | OMAHA
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State | NE
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Zip | 68127-1731
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Country | US
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Telephone | 402-592-1773
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Fax | 402-932-2547
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | PROF. MICHAEL P SWEENEY
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Credential | DDS
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Telephone | 402-592-1773
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 4890
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License Number State | NE
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