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General NPI Number Information
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NPI Number | 1306338595
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Entity Type | Organization
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Legal Business Name | DISTINCTIVE DENTAL CARE
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Dates
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Enumeration Date | 06/04/2018
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Last Update Date | 06/04/2018
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Provider Practice Location Address
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Address Line | 3201 PIONEERS BLVD STE 308
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City | LINCOLN
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State | NE
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Zip | 68502-5963
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Country | US
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Telephone | 402-441-4400
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Fax | 402-441-4403
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Provider Business Mailing Address
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Address Line | 3201 PIONEERS BLVD STE 308
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City | LINCOLN
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State | NE
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Zip | 68502-5963
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Country | US
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Telephone | 402-441-4400
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Fax | 402-441-4403
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Authorized Official
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Title or Position | OFFICE ADMINISTRATOR
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Name | MS. LIANNE SCISSORS
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Credential |
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Telephone | 402-441-4400
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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 |
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License Number State |
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