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General NPI Number Information
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NPI Number | 1215647805
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Entity Type | Organization
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Legal Business Name | METRO WEST DENTAL SPECIALTY GROUP
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Dates
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Enumeration Date | 12/05/2022
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Last Update Date | 12/05/2022
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Provider Practice Location Address
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Address Line | 12225 W GILES RD
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City | LA VISTA
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State | NE
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Zip | 68128-5801
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Country | US
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Telephone | 402-614-7022
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Fax | 402-614-7122
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Provider Business Mailing Address
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Address Line | 12225 W GILES RD
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City | LA VISTA
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State | NE
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Zip | 68128-5801
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Country | US
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Telephone | 402-614-7022
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Fax | 402-614-7122
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Authorized Official
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Title or Position | INSURANCE COORDINATOR
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Name | AMY MURILLO
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Credential |
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Telephone | 402-999-1016
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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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Taxonomy #2
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number |
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License Number State |
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