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General NPI Number Information
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NPI Number | 1164656781
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Entity Type | Organization
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Legal Business Name | OCEANS DENTAL, P.C.
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Dates
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Enumeration Date | 05/11/2009
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Last Update Date | 05/11/2009
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Provider Practice Location Address
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Address Line | 7555 S. 57TH STREET SUITE 4
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City | LINCOLN
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State | NE
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Zip | 68516
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Country | US
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Telephone | 402-423-9040
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Fax |
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Provider Business Mailing Address
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Address Line | 7555 S. 57TH STREET SUITE 4
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City | LINCOLN
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State | NE
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Zip | 68516
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Country | US
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Telephone | 402-423-9040
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Fax |
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | BRUCE ALAN CONDELLO
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Credential | D.D.S.
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Telephone | 402-423-9040
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State | NE
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