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General NPI Number Information
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NPI Number | 1194803262
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Entity Type | Organization
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Legal Business Name | PINE RIDGE DENTAL PC
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Dates
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Enumeration Date | 11/02/2006
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Last Update Date | 11/18/2024
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Provider Practice Location Address
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Address Line | 5140 S 56TH ST
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City | LINCOLN
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State | NE
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Zip | 68516-1832
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Country | US
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Telephone | 402-423-1100
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Fax |
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Provider Business Mailing Address
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Address Line | 5140 S 56TH ST
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City | LINCOLN
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State | NE
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Zip | 68516-1832
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Country | US
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Telephone | 402-423-1100
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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 | RICHARD NOLTE
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Credential |
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Telephone | 402-423-1100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State | NE
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