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General NPI Number Information
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NPI Number | 1285340380
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Entity Type | Organization
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Legal Business Name | JUSTIN SHIRK DDS LLC
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Dates
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Enumeration Date | 01/24/2023
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Last Update Date | 01/24/2023
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Provider Practice Location Address
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Address Line | 4444 S 86TH ST STE 101
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City | LINCOLN
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State | NE
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Zip | 68526-9253
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Country | US
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Telephone | 785-871-0692
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Fax |
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Provider Business Mailing Address
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Address Line | 1725 E PINE GROVE CT
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City | DERBY
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State | KS
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Zip | 67037-3950
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Country | US
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Telephone | 785-871-0692
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JUSTIN SHIRK
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Credential | DDS
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Telephone | 785-871-0692
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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 |
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